HomeMy WebLinkAboutDriveway Street Cut Permits 11 Stonefiel Permit No. 2971 Town of South Windsor, CT
Date 05/22/2000 Street Excavation Permit
Expiration Date 05/22/2001
Descrip:
Applicant
Location
Name BOUTIN & SONS STONEPJ ELD TRAIL
Addr. 121 WINDSORVILLE ROA
BROAD BROOK CT 060f16 dye ctf wank DRIVEWAY
Phone (860)623-2526
Applicant agrees d fUrhvsh the T ►n of SoLt Windisor the amount of bond
required and to reimbu-rsQ o.>TQwhl "�f= So4a,th Wvh0gor.for any expenses
incurred by the Town for �t a "ten �E,.�p pa r ork its connection with this
permit and that applicant Ie �fairr;� Wt t1L ,aaide by the rules and
regulations for permits.1ae,11,,011 ned 1n the Tfl r� :bf South Windsor' s Street
Cut Permit Manual.
* P RMIT TO BE KEPT' ON .`J9B SITE 'AT, ALL TIMES.
Issued by 7 T.atle
Date Completed..�,� Inspected By
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 one No ®G Q
Address of Firm
Location of proposed work `
Describe fully nature of permit requested '
Starting date Approx.time for completion
Call before you dig no.C24'-),W I Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North
Prop. size of cut
C�aC� No. cuts
Amt. of Deposit $ by
Cash O Check N
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.S.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: Date:
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES