HomeMy WebLinkAboutDriveway Street Cut Permits 55 Debbie Dr Permit No. 2967 Town of South Windsor, CT
Date 05/11/2000 Street Excavation Permit
Expiration Date 05/11/2001
Descrip: DRIVEWAY APRON
Applicant
Location
Name BOUTIN & SONS055DBBT,E DRIVE
Addr. 121 WINDSORVILLE ROAbA-J
BROAD BROOK CT 06.016 . DRIVEWAY
Phone (860)623-2526
Applicant agrees too 'fujrtjirs#�.' the "rywrt" � �" otj . Widsor the amount of bond
required and to re i mbu"rs a 'own of ,Ss� ith Wtii"",n pr-for any expenses
incurred by the Town for MA, tenarte0 lor, repair' lwbrk" in connection with this
permit and that app l i:carat`` s `f m� " - and ' �"1 I abide by the rules and
regulations for permits a "; o tl �n. � ;;Town"of= "8outh Windsor 's Street
Cut Permit Manual .
* PE IT Tp�" EPT .@? :;JC?B .5"TTE AT 'A" L TIMS.
Issued by Tit1"e
J
Date Complete - Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm / Phone No. Ct�r;)a
Address of Firm VT
Location of proposed work
Describe fully nature of permit requested JC -ke 5
Starting date Approx.time for completion
Call before you dig no. Zo 0 0 2 0 0 /L/:5 3 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit $ by
() Cash()Check#
Cut size after Perm. Patch
I No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R IIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES