HomeMy WebLinkAboutDriveway Street Cut Permits 2355 Ellingt Town of South Windsor , CT
o ;t No. 2429 Street Excavation Permit
Date 05i Q6/ 1 998
Expiration Dare L)rJ/ )6/.1999
Descrip: s Location
4 i
Applicant
55, 'ELLINGtON ROAD
Name BOUTIN & SONS
Addr . 121 WINDSORVILLE ROAD Type of -Work DRIVEWAY
BROAD BROOK CT 06016
Phone (66q)623-2526
the Town" Of Solut+ Wind or the amount of bond
Applicant agrees to furnish
r° for any expenses
or, m `rvi,"enant* or r6pair �t rl�. .n' connection
henruies andwith
required and to reimbfre " fo�h ofbuth W�h $�
the town t1aide by
incurred by `oLrth Vdindsor ' s Street
permit and that app l i czant '' atr W t t
ermi t aruti ned a n the
regulations for p
i3ut Permit Manual •
PERMIT TO BE KEPT .O J08aIT, A"� ,QLL TIMES .
* PE _- ,
Issued by
Inspected BY�____---------- —_—_
Date Completed
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 2, Phone No. (D
Address of Firm
Location of proposed work
Describe fully nature of permit requested T r
Starting date /Approx.time for completion
Call before you dig no. � f)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
r
No. cuts
Amt. of Deposit S by
O Cash O Check#
Ca* Cut size after Perm. Patch
No.Cuts
Final Billing S
' Out
Amt. Due Payee $
/ Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R;IMBURSE 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: 7 &YI Date:
Title: � if,� (�Q.Q D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES