HomeMy WebLinkAboutDriveway Street Cut Permits 60 Gray Road Permit No . 3033 Town o South Windsor, CT
Date ea 1 0/04/2000 Street Excavation Permit
r
Expiration Date 10iO4/2001
Descrip :
Apc? i I Locati o.
Name BOUTIN & "iONS 060 GRAY ROAD
Addr . 121 WINDSCJRVILLE ROAD S
BROAD BROOK CT 06016 Type of- Work DRIVEWAY
Phone (860 )62 -2526
Applicant agrees to furnish 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. connect-Qon w; th this
permit and that applicant is familiar with and will abide by the rules and
regulations for permits as outlined in the Town of South Windso-' s Street
Cut Permit Manual .
* PERMIT TO BE KEPT ON JOB SITE AT AL TIMES. �
Issued by .__._ _ '"�-- Title
Da c.e Completed _ �_ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
r TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
_ ._ TOWN HALL_
1540 SULLIVAN AVENUE
SOUTH WINDSORF CT
FEE $25.00
Name of Firm Boutin & Sons Const. Co. 623-2526
Phone No
Address of Firm rn sorvz e oa oo ,
Location of proposed work tin Cray g o a d
Describe fully nature of permit requested rip r i v e
Starting date Approx.time for completion
Call Before You Dig No.20004100311 Traffic Services Control No.
Show sketch of proposed work or furnish To he filled out by To of South W_ indsor
two copies of separate drawing
Pavemeat .t .
Indicate North 'e `
Prop.size of cut,
2 No.cuts
Amt.of Deposit$ b
Y
{)Cash O Check#
Cut size after-Perm:Patch
-- Now Cuts-
Final Billie
Amt. Due Town$
Applicant is responsible for c tacting 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: Date: 10/2/00
Title: Secretary
D.L.#c
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES -
Standard Forms\Permits\Street Excavation Permit.doc