HomeMy WebLinkAboutDriveway Street Cut Permits 132 Orchard r
Permit No. 2885 Town of South Windsor, CT
Date 10/25/1999 Street Excavation Permit
Expiration Date 10/24/2000
Descrip:
Applicant Location
:•
Name BOUTTN & SONS '2 ORCH RD HILL DRI
Addr. ..121 WINDSORVILLE ROAb'
BROAD BROOK CT 06016 "Type of_. Wark DRIVEWAY
Phone (860)623-2526
Applicant agrees i o u:rnJ-4h the Tb"wn of South. Windsor the amount of bond
required and to reimburselrHe''Tor C� Spth W7 r.. for any expenses
incurred by the Town for �afntenar�ce or. repai r 'work in connection with this
permit and that app i i carrt� °:fa* gar .W. and',will-abide by the rules and
regulations for permi is l.4s xi lined 'n the' Town�:of South Windsor's Street
Cut Permit Manual .
* P RMIT TO B KEPT ON Jt36 SIT-ET ALL TIMES.
Issued by Title
Date Compl�tei Inspected B p y ..
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
-PUBLIC WORKS"DEPARTMENT--
TOWN HALL _
- 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No —�
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call.Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
Gar
No.Cuts
Amt.of Deposit$ by
O Cash O Check#
9
Cut size after Perm. Patch
No. Cuts
Final Billing$
Due Payee$
Amt.-Due Town$
Applicant is responsible for contacting by date
the PoliceDept.and C.B.Y.D.
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 S UTH WINDSOR'S STREET CUT PERMIT MANUAL.
A19t.,
Signed: Dater .
Title: D.L.#: .
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc