HomeMy WebLinkAboutDriveway Street Cut Permits 89 Robert Dr Town of
South wzndsor , CT
2347 street EAcavat"on Permit
Permit No. 03/10/1997
Date -
._ t
Expiraion Date 09/ 10/ 199B
t
Descrip: RECONSTRUCT DRIVE.WA'i
1_c� at arl
kpp i i cant
0089 ROE ERT DRIVE
Name BOUTIN & SONS
Addr . 121 wINGSC:RVILLE R'SAG Type Of work DRIVEWAY
BROAD BROOK: CT 06016
Phone (86o)623-2526
Applicant agrees to furnAsh: t he Town of "South Windsor the ainof bond
ice or repair 'µt6rh i n connecti on
rules and
u i red and to reimburse the Town of '$0uth Windsor f or' any expenses
required the Town for main tenan
incurred by licant "is faMi1,far with and `wi � 1 abide by th
permit and that app
regulations for
- permits
as outlined in° the Towr'► o'f 'South Windsor' s street
Cut Permit Manual .
* �c PERMIT-
Tit°TO BE kEPT ON JOa SITE AT TIMES
.�
-
issued by _ - — -r— -
' I n s p e cl-l e d BY
Date Completed
APPLICATION FOR STREET EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm Q C Phone No. �,
Address of Firm '
Location of proposed work 1
Describe fully nature of permit requested
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be fiUed Out by Town Of SO Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
^— •f �(.J ' No.cuts
Amt.of Deposit$ by
Cash O Check#
�7 I ^
( ,�l/f,,-%U r�,C� Cut size after Perm. Patch
�9 t
0 No.Cuts
4�1
i Final Billing$
1
1 Amt. Due Payee$
l
$
Applicant is responsible for contacting Amt.Due Town
the Police Dept.and C.B.Y.D. by date
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 THA I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH INDSOR'S STREET CUT PERMIT MANUAL.
Signed: 24 Date:
Title: 1 D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES