HomeMy WebLinkAboutDriveway Street Cut Permits 137 Farnham Permit No. 2702 /-z Town of South Windsor, CT
Date 05/27/1995 ' Street Excavation Permit
Expiration Date 05/26/2000
Descrip:
Applicant Location
7
Name BOUTIN & SONS , r_ ARNH1 ROAD
Addr. 121 WINDSORVILLE ROAd
BROAD BROOK CT 060.16 of€ �fdrk 'DRIVEWAY
Phone (860)623-2526
Applicant agrees o Ury the Tq�
k of J nd or the amount of bond
required and to re i mbuer ? To �t�th '. M r r any expenses
incurred by the Town 'for i a�Wtenanq o" `epa � �c i n connectpon with this
permit and that applilt&r��t ' w° f ' ,e"
regulations for permi t; � ` � ' " ' � � � ai de by the rules and
s �ned �� the OW ettSouth Windsor' s Street
Cut Permit Manual "� ���
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* * PERMIT TO" 0'E° � _. � FOALL TIMES.
Issued byj��s"
Date `Completed I
/ z 9
J � �_ nspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No
Address of Firm . ' '
Location of proposed work
Describe fully nature of permit requested lL
Starting date Approx.time for completion
Call Before You Dig No. /9g9 2 Zd/5 Flo Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by T of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
I Amt.of Deposit$ by
O Cash O Check#
r C) t4 Cut size after Perm. Patch
No. Cuts
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 WINDSORIS STREET CUT PERMIT MANUAL.
Signed. Date: t
Title: ' D.L.#:
_ b
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIM90
Standard Forms\Permits\Street Excavation Permit.doc