HomeMy WebLinkAboutDriveway Street Cut Permits 76 Kent Lane s Town of South Windsor , CT
Permit No. 2493 Street Excavation Permit
Date 09/23/1998
Expiration Date 09/2-3/19991
D e s c r i p:
Applicant
Location
Name BOUTIN & SONS1376 KENT LANE
Addr . 121 WINDSORVILLE ROA[ -Ypeof. Work 'DRIVEWAY
BROAD BROOK CT 06016
Phone (860)623-2526
Applicant agrees to furnish ,the 'Town ",of, South' Windsor atheny eamount
of bond
forrequired and to reimburse the Town of South ?n s
incurred by the Town for r' Work `'3n connection with this
ca° iliar w9 aQnW� lSoutheWbndsoe' sules Street
permit and that appli d
nt fam
regulations for permits as�°,outline ln..tl�e T
cut Permit Manual .
* * PERMIT TO BE', K KEPT; N JC►@ ;SITE AT ALL TIMES .
Issued by Title
Date completed inspected By
dcifi
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm5 � r Phone No. —'
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date �Approx. time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So..Windsor
two copies of separate drawing Pavement_ Cut
Indicate North
Prop. size of cut
No. cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing S
Amt. Due Payee S
$
Applicant is responsible for contacting Amt. Due Town
the Police Dept. and C.S.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 RULE 'A!f� TIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
EP e:
Title:
SOUTHPIADf)
ENG.DEPT.
'Q
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES