HomeMy WebLinkAboutDriveway Street Cut Permits 57 Palmer Dr Permit No. 2662 Town of South Windsor, CT
Date 04/26/1999 Street Excavation Permit
Expiration Date 04/25/2000
Descrip:
Applicant -° Location
Name BOUTIN & SONS ,DRIVE
Addr. 121 WINDSORVILLE ROAp w
BROAD BROOK CT 06016
DRIVEWAY
ype cif Wor`xc
Phone (860)623-2526
App l i cant agrees
� �� yf Slil or the amount of bond
required and to reimk�u �e the Town Qi' nth W � r -fir any expenses
incurred by the Town for °m�`iritett ��""' "repair .rid connection with this
permit and that app17 a t fart a ft ar, 1 abide by the rules and
regulations for permits'�'''es =atet '►n�� 1�r t s� * cz n .bf buth Windsor's Street
Cut Permit Manual . °
3 r
* * PERMIT TO 6e "`ALL TIMES.
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Issued by ::5. �k�jA 'T-r 1
Date Completed
Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $2S.00
Name of Firm7R�, 11 Phone No. Lio� eta) b
Address of Firm_ 5
Location of proposed wor
Describe fully nature of permit requested t
Starting date Approx.time for completion
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
G4 r
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt.-Due Peyeee
Amt. Due Town$
Applicant i responsible for contacting by date
the Police Dept.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 SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
r
Signed: Date: f
Title: D.L.#:
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard,Forms\Permits\Street Excavation Permit.doc