HomeMy WebLinkAboutDriveway Street Cut Permits 28 Rockledge Permit No. 2922
Town of South Windsor, CT
Date 03/20/2000 Street Excavation Permit
Expiration Date 03/20/2001
Descrip:
Applicant Location
Name BOUTIN & SONS
Addr. 121 WINDSORVILLE RQA OU2 -' 2OCKED(3E DRIVE
BROAD BROOK CT 06016`. 'hype of. Wo ` DRIVEWAY
Phone (860 )623-2526
Applicant agrees 1 0 d,rn` , the S�Suth Windsor the amount of bond
required and to reim u�rs Vie° To, o�, ; ?w i h Wfrjd�or. for any expenses
incurred by the Town 'foren�e or Oepai rr" Work in connection with this
permit and that appli"ca.t� ftttre^.` th andtl,t .;abide by the rules and
regulations for permi ts : e +� 1 i `d "err��th+e`Tpwi�....of South Windsor ' s Street
Cut Permit Manual .
* * PERMIT T KEPT�' ON JaB;,SI7E ..AT..ALL TIMES.
Issued by
-- —_,Title _ ; art
- —
Date Completed __ Inspected By
T SC)urh WInasor , CT
Date 03/20/200() ;street Eycavat 7,,•.ri
er'rni t,
Expiration Dare 03/20/2001
Descrip;
Applicant.
ocat on
Marne BOUTIN & SONS 0028 RO CKLEDGE DRIVE
Addr. 121 WINDSORVILLE ROAD
BROAD BROOK CT 06016
Phone , 860 )623-2526 Type of Work DRIVEWAY
Applicant agrees to furnish the Town of South W 1 nasc.)r i-he arnounr ,)f Dond
required and to re mnunse the ;own of South Windsor tor, any expenses
incurred .by the Town for Maintenance or repair work it connectior) w th ;.n-;s
permit and applicant is 11-am1 l i ar with and will ab—f de b�' the rra)as an+:j
regu lations for perm l is as c ut'i i ned i n the Town of Sputh 'W i ndsor ' s Street
CLit Permit MaMia 1 .
E'.ERMI I BE KEPT ,ON J3,08 SITE AT ALL i 1ME .
issued by ....... TItse
Date Comp i at..ea, r
1 80ec r ed ?,�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm 1 Phone
No.
Address of Firm Y,Location of proposed work
Describe fully nature of permit requested 1(' a �/
Starting date Approx.time for completion
Call Before.You Dig No. [j �6l 9! Traffic Services Control No.
Show sketch of proposed work or furnishwo copies of separate drawing ��fined ou#by Town of South Windsor
t
Pavement ut
Indicate North Prop.size of cut
0.� No.cuts
Amt.of Deposit$ b
,Y
{)Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is re nsible for contacting b
the Police De t.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 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:
Title: t _ D.L.#:
v
F '
PERMIT SHALL BE KEPT ON 7OBSITE AT ALL TIMES.
Standard FormsTermitAStreet Excavation Permit.doc