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HomeMy WebLinkAboutDriveway Street Cut Permits 52 Hollis Ro Permit No. 2972 Town of South Windsor, CT Date 05/22/2000 Street Excavation Permit Expiration Date 05/22/2001 Descrip; Applicants Location Name BOUTIN & SONSHOLI , ROAD Addr. 121 WINDSORVILLE ROA BROAD BROOK CT 06a`16 T-yP df 'Wd' k -DRIVEWAY Phone (860)623-2526 Applicant agrees to €uf� sh tie T �1= Sbuth 'Windsor the amount of bond required and to re i mbu'r � TOW6 �r �, S th I�1 sn r any expenses incurred by the Town for 'Af(V e a © �pai lr� 6ekIn connection with this permit and that app7 ioantf21 � ;x wln+ rrla , abide by the rules and regulations for perm7s,` a n tie Try a .,.gputh Windsor's Street Cut Permit Manual . * * PE EMIT TO 13 fEPT 0N' :1OB SITE'',AT' ALL TIMES. Issued by �J Title Date Complet d 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 one No. C Address of Firm Location of proposed work Describe fully nature of permit requested Starting date Approx.time for completion Call before you dig no. 2 0 0 0 21 o Z $ S 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 Gkh No.cuts Amt. of Deposit $ by ()Cash() Check A Cut size after Perm. Patch No.Cuts Final Billing $ 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 1MBURSE 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- Title: D.L.ff PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES