HomeMy WebLinkAboutDriveway Street Cut Permits 377 Smith St Permit No. 2309 Town of South Windsor-, CT
Late 36I �5/1 '' Street, Excavation Permit
Lxpirati on Data 06/05/1 98
Des;r i p: DRIVEWAY STREET OUT PERMIT
1
Applcant cation,
Name BOUTIN & SONS Oa,77 SMITH STREET
Addr. 121 WINDSORV'ILLE POAD
BROAD BROOK CT 06016 Type of wort,: DRIVEWAY
Phone (860)623-2526
Applicant agrees to furnish the Town of South Windyor the amount of done
required and to re1mbur:se ^the Town cif South Windsor for any expenses
incurred by the Town for maintenance or repair work in connection with this
permit and that applicant i s f am' 1 ar with 'arid w 1 i 1 ' abide by the rules and
regulations for permits �s outlined in the Town of 'South Windsor ' s Street
Cut Permit Manual .
PERMIT TO BE KEPT OIN JOB SITE AT ,ALL TIMES.
<,� f t w T i tr 1 e rt:P _ _ __ �.____ r
Issued by {u �!�._ ____�____ �____. — ..
Inspected By
Gate Completed _._-_-------
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm 1 S
Address of Firm r Phone No. 3-
r
Location of proposed work
Describe fully nature of permit requested
Starting date )
Call before you dig no. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So W
two copies of separate drawing indsor
Pavement-- Cut
Indicate North
Gr Prop.size of cut
l No,cuts
Amt.of Deposit p $ by
()Cash()Check#
Cut size after Perm. Patch
/ No.Cuts
Final Billing$
Amt.Due Payee$
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 THAT 1 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
S
Date:_
Title:
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES