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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No Contractor BOUTIN & SONS
Location a ' .. Address 121 WINDSORVILLE ROAD
Type Work DRIVEWAY ,� BROAD BROOK CT 06016
No. (860)623-2526
Date Insp Needed n d
Time Insp Needed
Inspected By
Work in Progress
k
Date
der &&.t No. 3391 Town of South Windsor , CT
Date ` 09/13/2002 Street Excavation Permit
Expiration Date 09/13/2003
Descrip:
Applicant 41 Location
Name BOUTIN & SONS BROOK DRI
Addr. 121 WINDSORVILLE t .
BROAD BROOK CT 06 1 k DRIVEWAY
Phone (860)623-2526
Awk
Applicant agrees t Tin sor the amount of bond
required and to rei s T th o� or any expenses
incurred by the Town � to epa n connection with this
permit and that appl 6aih bide by the rules and
regulations for perm t line uth Windsor's Street
Cut Permit Manual . {�
m
* * PERMIT T ALL TIMES.
Issued by "�, A e �(Zds. FNG-
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
Address of Firm Phone No. a
Location of proposed work
Describe fully nature of permit requested
UM
Starting date Z.
Call before you dig no. APP►ox.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing TO be filled out b Town of So. Windsor
Pavem--- maLgyt
Indicate North
J Prop.size of cut
I ( No.cuts
Amt. of Deposit S by 1
Cash O Check#
Cut size after Perm. Patch
0
No.Cuts
Final Billing S
Amt. Due Payee $
Applicant is responsib for contacting Amt.Due Town $
the Police Dept.and C.S.Y.D.
date
I AGREE TQ FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECT IS
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:
Date: Z
Title: '
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES