HomeMy WebLinkAboutDriveway Street Cut Permits 68 Kelly Roa P4,rmit No. 2435 Town of South Windsor, CT
Date 05/19/1998 Street Excavation Oermit
Expiration Date 05/19/1999
Descrip:
.Ms.
Applicant Location
Name 8OUTIN & SONS � � � � KLYOAD
Addr. 121 WINDSORVILLE ROAD � " � �
BROAD BROOK CT 0601i , � o p RIVEWAY
Phone (860)623-2526 �
NZ
Applicant
Applicant agrees to Wi° Sor the amount of bond
required and to reimburse 1 1-ow Pbcfth 4a"
4 err any expenses
ncear pai
incurred by the Town , or
frn connection with this
permit and that applidari, ' �i a '� and 21 ide by the rules and
regulations for permits slit11owYSpf oth Windsor's Street
Cut Permit Manual .
* * PERMIT T& B a"4CL� ��r TA-ALL TIMES.
Issued by
Date Completed "'" 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' Phone No. (c�
Address of Firm
Location of proposed work — ,' CJ
Describe fully nature of permit requested
Starting date Approx.time for completion
Call before you dig no. 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
Amt.of Deposit S by
1
(� ()Cash(1 Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee S
Amt. Due Town S
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 ReMBURSE 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 SOU WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: cam(} A t1 Ag,� D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES