HomeMy WebLinkAboutDriveway Street Cut Permits 154 Scott Dr Fyermi't No. 2763
Town of South Windsor, CT
Date OT/14/1999 Street Excavation Permit
Expiration Date 07/13/2000
Descrip:
Applicant Location
Name BOUTIN & SONS ��� (7154,>SCp '4 DRIVE
Addr. 121 WINDSORVILLE RQAQ `r
BROAD BROOK CT 060, 16 !" of dt �bRIVEWAY
Phone (860)623-2526
Applicant agrees th"Jfur,ti# `th a�T� t �,� 0",`, j,ndtor the amount of bond
required and to re a m0,4rr � o
r ' ,r any expenses
incurred by the. Town for ra en4paaV4� connection with this
permit and that app 1 a oint � � �
All 4 i de by the ru 1 es and
regulations for perms i ned ' t � fSuth Windsor's Street
Cut Permit Manual .
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*jj PERMIT �BE�� 81LL TIMES.
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Issued by '
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Date Comp 1�t�d
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 0 Pon e No. to01
Address of Firm
Location of proposed wor
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before,You Dig No. / 9;Z 22d l l-Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
GX;Ql� No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm.Patch
No. Cuts
Final Billing$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.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 SOUT WINDSOR'S STREET CUT PERMIT MANUAL.
i
Signed: Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc