HomeMy WebLinkAboutDriveway Street Cut Permits 95 Greenfiel Permit No. 3083 Town of South Windsor, CT
Datt- r 04/12/2001 T -7- Street Excavation Permit
Expiration Date 04/12/2002
Descrip:
Applicant Location
Name BOUTIN & SONS ll
E
Addr. 121 WINDSORVILLE ROAb ,,
BROAD BROOK CT 060 �'6 y1pe }�W " " DRIVEWAY
Phone (860 )623-2526
Applicant agrees tounief "'the `" iu lindsor the amount of bond
required and to reimburse thetfowrl S uiyh W1r CCsor -for any expenses
incurred by the Town ;for 0,4Tritenr�ace "�epaY r, k connection with this
permit and that app l c n i s fare I a��* 4r t,,h and. �rt1 1. abide by the rules and
regulations for permits �a ;ttY" e "; "� g"";oy� "p South Windsor's Street
Cut Permit Manual .
* * P RMIT TO' BE kf�PT CAN" JCS$ ",S�;TE AT "ALL TIMES .
Issued by - Titl`e
Date Compi ted ) 12- Inspected By _
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APPLICATION FOR STREET -
EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT07
TOWN HALL
1540 SULLIVAN AVENUE
SOUTHWINDSOR, CT
FEE $2S.00
Name of Firm Boutin & Sons Const. Co. 623-2526
Address of Firm 121 Windsorvi l le rd Broa rook a No.
Location of proposed work
9 Green ie rive
Describe fully nature of permit requested Reconstruct Exis Ina riveway
Starting date
Cafi Before You Dig nio. Approx.time for completion
Traffic services Control No.
Show sketch of proposed work-or furnish
two copies of separate drawing To be filled out by Town of South Windsor
Indicate North Pavem n r,,r
Prop.size of cut
No.cuts
Amt.of Deposit b
y
Cash{)check#
S Cut size after Perm.'-Patch
No. Cuts
Final Billing$
i
7 Amt. Due payee
Amt. Due Town$
Applicant is responsible for contacting
the Police ne -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
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCEEIMBURSE THE TOWN OF
OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL-ABIDE BY THE RULES AND REGULATIONS FO
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. R PERMITS AS OUTLINED IN THE
Signed: 4/1.0/01_
Date:-:
Title: -- Secretary
D.L.#:.
,
PERMIT SHALL BE KEPT ON]OBSITE.AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc