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HomeMy WebLinkAboutDriveway Street Cut Permits 18 Norma Roa y l Permit No. 2421 Town of South Winasor, CT Date 04/23/ 1998 Street Excavation Permit Expiration bate Descrip: t. . a - Applicant r Location` Name BOUT IN & SONS0 8, NOR MA Ps7AD Addr . 121 WINDSORVILLE ROAD BROAD BROOK CT 06016 TY(pe; o.f Worl,,: DRIVEWAY Phone (860 )623-2526 Applicant agrees to fur-ni$h the .Town Qf S©uth Winds+cr the amount of bond required and to reimburse the Town of S.fluth WIn"dsor for any expenses incurred by the Town for ; m'ai ri'tenano. �or'� r"$pai r we.r;; i r�' connection with th i s permit and that applicant # ;fa'm'4" 'i#r; w tta nd.-av"i'f l.. tide by the rules and regulations for perm i ti �`as �.c*u"t'l i rued 1 h� the Ta�rra ��- .Sor th Windsor' s Street Out Permit Manual . PERMIT TJ `B klrk'T', 1'„Jv'�B , I'i ;." R`LL 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 $25.00 Name of Firm Phone No. In !� Address of Firm Location of proposed work Describe fully nature of permit requested Starting date Approx.time for completion Call before you dig no. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So. Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit$ by (1 Cash(1 Check# Cut size after Perm. Patch No.Cuts Final Billing$ CAmt.Due Payee $ Amt. Due Town $ Applicant is responsible for contacting the Police Dept.and C.S.Y.D. by date 1 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: Data:- Title: ( D.L.# v s PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES