HomeMy WebLinkAboutDriveway Street Cut Permits 175 Judy Lan Permit No. 2669 Town of South Windsor, CT
Date 05/03/1999 Street Excavation Permit
Expiration Date 05/02/2000
Descrip: "
Applicant
: Location
Name BOUTIN & SONS f0i7 p} M E
Addr. 121 WINDSORVILLE RdA�
BROAD BROOK CT 06016 hypeC DRIVEWAY
Phone (860)623-2526 r 1
Applicant agrees to", t ,c !f Sqr lNneior the amount of bond
required and to reimt(I Town„ .'' h Wt r fOr any expenses
incurred by the Town f i. , � �
aie *k �"kvj connection with this
permit and that app 1 i 4a, "', a a+ � r� -1 �' bide by the rules and
regulations for permitt'P'I's" �,
Guth Windsor's Street
Cut Permit Manual . lk�
^� J
>t,a+v ^'7r-s * y.�! d"P �` pub,,.
* * PERMIT TO F . C�fV��� .. ,7 ALL TIMES.
Issued by
5
Date Completed E9 Inspected By
y
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm
Address of Firm Phone No.
Location of propose work
d
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig o. Traffic Services Control No.
Show sketch of proposed work or famishWiindsor
two copies of separate drawing !!
Indicate North Pavement Cut
Prop.size of cut
Gar No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
_.. No. Cuts.
Final Billing$
Amt. Due Payee$
Amt.Due Town$
Applicant is responsible for contacting by
the Police De .and '.B.Y.D. 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:
Dater
Title:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc