HomeMy WebLinkAboutDriveway Street Cut Permits 265 Diane Dr Permit No. 2785 Town of South Windsor, CT
Date 07/28/1999 Street Excavation Permit
Expiration Date 07/27/2000 Fib'
Descrip:
Applicant Location
Name BOUTIN & SONS42C ,[ IAlVE-<r DRIVE
Addr. 121 WINDSORVILLE ROAJ ,:�'�
BROAD BROOK CT 060116 Typ1y f Wo,r,, ,DRIVEWAY
Phone (860)623-2526
App1 icant agreesurrrt the .Y�wn # S th Vi dsor the amount of bond
required and to reimburse' , e;`tovr�.;Af Seth "Windsor f+or any expenses
incurred by the Town fr rT,,tenange ar impair - h connection with this
permit and that app 1 i its `fa,iIrt ands abide by the rules and
regulations for permits as ,�. 1'��rt ; Tt df ° South Windsor's Street
Cut Permit Manual .
* PERMIT TO,"B1r KAI` t3fi# cSTE AT'' ALL TIMES.
j Issued by T.i t
Date Comple d
Y.Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 7
1 Phone N .
Address.of Firm
Location of propose work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control:No.
Show sketch of proposed work or fumish To be filled out by Town of South Windsor
two copies of separate drawing
�,. Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash()Check#
Cut size after Perm. Patch
No. Cuts
j 1 Final Billing$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE 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 SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed A Date:
Title:— D.L.#•
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc