HomeMy WebLinkAboutDriveway Street Cut Permits 24 Saginaw S H
Permit No. 2672 G Town of South Windsor, CT
Date 05/03/1999 Street Excavation Permit
Expiration Date 05/02/2000
Descri
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Applicant Location
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Name BOUTIN & SONS �� dq It ' STREET
Addr. 121 WINDSORVILLE R,
BROAD BROOK CT 06('16 � rpe � ypr RIVEWAY
Phone (860)623-2526
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CAS
Applicant agrees iaoy t� ,f Sl� dor theamount of bond
required and to reimb�ur^ e Town h W 11"t"
r fpr any expenses
incurred by the Town f+ {nt aii connection with this
permit and that appli4a , °r a� 1labide by the rules and
regulations for Perm 1tis as �� I� �� ao 5 uth Windsor 's Street
Cut Permit Manual . '
* PERMIT TO V �" ALL TIMES.
Issued by "�. ��Ln�AIR' 't 1 e
Date Completed — Inspected By 42�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN.HAkL
1540 SULLIVAN AVENUE,
SOUTH WINDSOR 'CT
FEE $25.00
Name of Firm S hone No. d�a
Address of Firm T
Location of proposed work
Describe fully nature of permit requested 4Lt ILA
Starting date Approx.time for completion
Call f Be ore You Dig No. Traffic Services Control No
.
Show sketch of proposed work or furnish To be filled out by Town of Sduth Windsor
two copies of separate drawing
Pavement Cut
Indicate North `o Prop.size of cut
l No.cuts
r Amt.of Deposit$ by
Cash O Check#
% Cut size after Perm. Patch
No. Cuts
j
Final Billing$
lDm@ payee
Amt. Due Town$
Applicant is responsible for conta ing by date
the Police De t.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: Date: a 7
Title: D.L:
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PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard_Forms\Permits\Street Excavation Permit.doc -