HomeMy WebLinkAboutDriveway Street Cut Permits 15 Diane Dri Permit No. 2479 Town of South Windsor , CT
Date 08/04/1998 Street Excavation Permit
Expiration Date 08/04/1999
Descrip: CK 122 - 5 PERMITS
.Applicant Location
Name BOUTIN & SONS DRIVE
Addr. 121 WINDSORVILLE ROAD,,"
BROAD BROOK CT 0601 DRIVEWAY
Phone (860)623-2526
Applicant agrees to Sdi # rWindOor the amount of bond
required and to reimburse wn f Sc �ic rr 'dr any expenses
incurred by the Town i�o ', r nab a` pa 5i connection with this
permit and that app 1 i Catat fermi 1 i an' ;��aI de by the rules and
regulations for permits .:ems o l� � � wTow SwF 'i�dth Windsor's Street
Cut Permit Manual .
,
* PERMIT " � e
TgAL TIMES.
Issued. by
Date Comple ` erected By
APPLICATION FOR STREET EXCAVATION PERMIT VVV
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL -
1540 SULLIVAN AVENUE '
SOUTH WINDSOR,
�2 I�2D5 OOR' CT
�w
Name of Firm Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested ,/
Starting date �Approx.time for completion
Call before you dig no. 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 S by
O Cash O Check#
Cut size after Perm. Patch
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 RFII,MBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUT WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
rC O �
Title: D.L.B
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES