HomeMy WebLinkAboutDriveway Street Cut Permits 39 Quarry Br Permit No. 2993 Town of South Windsor, CT
Date 07/14/2000 Street Excavation Permit
Expiration Date 07/14/2001
Descrip: WIDEN DRIVEWAY REMOVE PORTIO,N, C1f„SW
Applicant Location
Name HOMEOWNER 0a3+3 QAf 3FtY BROOK DRI
Addr. SAME AS ABOVE
. SOUTH WINDSOR CT 0 074 , Type cif W4t"k DRIVEWAY
Phone (000)000-0000
Applicant agrees to`furrlsh the fown::a aouth`',Windsor the amount of bond
required and to reimburse overt: -of S+�uth Windor for any expenses
incurred by the Town for ait er arace.,or. r'.'epai`r,'Work in connection with this
permit and that appl i�c rit 1:; f r l i a~ w.3# :� and I Y a i de by the rules and
regulations for permits :as`-d l'iii 4n—the Town,,of`'South Windsor' s Street
Cut Permit Manual .
* * PERMIT TO BE KEP , C3N ' JOB,,$iI`E .AT ALL TIMES.
Issued by - ---�: _ T i t 1 e .-�._ of,,
Date Completed _ Inspected By _
� V
APPLICATION FOR STREET EXCAVATION
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TOWN OF SOUTH WINDSOR PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $2S.00
Name of Firm h C,
Address of Firm P ne No.
Location of proposed work J c.-
Describe fully nature of permit requested
Starting date / p
Call Before You Di No. Approx.time for pletion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawingA To be filled out b Town of South Windsor
f�
Indicate No Pave—_ me_ nt Cup
` Prop.size of cut
No.cuts
Amt.of Deposit$ . b
Y
O Cash O Check#
• i
l Cut size after Perm, Patch
No. Cuts
1 Final Billing$
QuQ�r oror a« Amt. Due Payee$
$
Applicant is responsible for contacting Amt.Due Town
the Police De .and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNE
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES FOR AN PER ITS
THE TOWN OF
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. D REGULATIONS CTIOI WITH THIS
S AS OUTLINED IN THE
Signed:
Title: Date:
IZ6 (0
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc