HomeMy WebLinkAboutDriveway Street Cut Permits 75 Horizon C Permit No. 2860
Date 09/13/1999 Town of South Windsor, CT
Expiration Date 09/12/2000 Street Excavation Permit
Descrip:
ApPlicant
Name BOUTIN & SONS . Location
Addr . 121 WINDSORVILLE RC?Ap
01�.T HORIZON CIRCLE
BROAD BROOK CT 06016 :~
Phone (860)623-2526 Wrk ,pRIVEWAY
Applicant agrees do Nill s� they TOWn of Souy,
required and to reim a se ,; e .Toy, nth i r.ndsoratheny eamoun sof bond
incurred by the Town foraiDena o repast' r i connection with
permit and that app1icarrt 3 f far- It ,and �� 1I abide by the ruses and
regulations for perms iKs � u ,l i nevi i n theOwn`,-,-,',Of, South W i y the s Street
d
Cut Permit Manual . t
R
* RMTT TO' EPT SITE q'T ALL TIMES.
Issued by ----- �-
Title — r
Date Comp1 to
Inspected By
APPLICATION
OWON OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. 6
Address of Firm
Location of proposed work
Describe fully nature of permit requested cmi
Starting date /Approx. time for completion
Call before you dig no. f 9 'j 7 3-,74 2 Z A 9 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
No. cuts
r
Amt.of Deposit S by LC—I)A
O Cash O Check A
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee S
�! Amt. Due Town 4
Applicant)responsible for co tatting
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 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:
Title: D.L.N
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES