HomeMy WebLinkAboutDriveway Street Cut Permits 110 Farmstea Permit No. 2471 Town of South Windsor, CT
Date 07/23/199a Street Excavation Permit
Expiration Date 07/23/1999
Descrip: CK122 - 5 PERMITS
Applicant
x Location
Name BOUTIN & SONS �. ,6110 FARMS*EAD DRIVE
Addr. 121 WINDSORVILLE ROA[�-��
BROAD BROOK CT 0601 .� 'DRIVEWAY
Phone (860)623-2526
Applicant agrees to f�rr�4�M_- irha° '�a �;-
544ifidsor the amount of bond
required and to re i mb rae °1 Tow �,h 4 n SO fo any expenses
incurred by the Town fox �aa n nand b ' pair .. k;in connection with this
permit and that app 1 i c an-` arn., and r�F 1°1, �t i de by the rules and
regulations for permit a�s'` �11i r ,a� .� to� 1 S { th Windsor's Street
Cut Permit Manual .
x,
* * PERMIT T6,
.BE ,KEPT ON JC?RIrr ,AT A[:L TIMES.
Issued by ,,G,%�, T'7.tls
Date Completed 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 r
Phone o
Address of Firm
Location of proposed work
Describe fully nature of permit requested z!
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 bV Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop. size of out
No. cuts
Amt. of Deposit $ by
O Cash O Check k
/ Cut size after Perm. Patch
No.Cuts
if
Final Billing $
Amt. Due Payee S
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
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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: l Date•
Title: ( D.L.B
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES