HomeMy WebLinkAboutDrain Layers Permit 180 Dogwood Lane BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date 18 July, 1974
MUNICIPAL BUILDING
Am't on File 1540 SULLIVAN AVENUE Permit No. 19
SOUTH WINDSOR, CONNECTICUT
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00
Name and address of applicant Pollution Control Dept. Phone No. 289-0185
Location of proposed work 180 Dogwood Lane B
Describe fully nature of permit requested Pavement c p
above address to M/H Sta 23+00.6.
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
Show sketch of proposed work or furnish 2 copies of separate drawings
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v Permit taken out to cover work performed by private contractor -
a Lamson Construction - for Pollution Control Department.
I agree to furnish to the Town of South Windsor the amount of bond or deposit 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 (Pavement Cut Regulations.)
T.O.S.W. Highway Dept. to cut and Po ution ontrol D artment
repave.
Signe Mel n dwards, J` .
APPROVED. DATE APPROVED: DATE
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started 7/18/74 Date completed 7/19124
Sufficient notification received: yes no Type of repair: Perm. I=DPI
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
\ Inspector