HomeMy WebLinkAboutDriveway Street Cut Permits 81 Palmer Dr .e-
Permit No. 2656 Town of South Windsor, CT
Date 04/16/1999 Street Excavation Permit
Expiration Date 04/15/2000
Descrip: CK 4110 2 PERMITS
Applicant
Location
Name BLUE DIAMOND PAVING ^I1d ,. LMty DRIVE
Addr. 1064 EAST ST NORTH
SUFFIELD, CT 0607811 .. � y r ► ,DR.IVEWAY
Phone
Applicant agrees to *furta � theft n
Qt ,thVtndoor the amount of bond
required and to reimbue\ Tom berth Vvnicar Ypr any expenses
incurred by the Town i�nten�anp 0pa f 4b "k in connection with this
permit and that app 1 i ' f anc i de by the rules and
regulations for permits". sfttl ;nrfth Windsor' s Street
Cut Permit Manual .
* * PERMIT TO ,. KP CV ` �W.STE AT ,ALL TIMES.
1' w
Issued by � �,'F�t1er,
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 $25.00
Name of Firm ��� v U) Phone No.
Address of Firm O 0
Location of proposed work Aktm 2 r
Describe fully nature of permit requested P,,A
Starting date Approx.time for completion qe)AL
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North 1 Prop. size of cut
() No. cuts
A)R0 Gi✓� Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is 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.
Signed: 6�1
g Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 7OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc