HomeMy WebLinkAboutStreet Cut Permit 374 Abbe Road Extensio BOND TOWN OF SOUTH WINDSOR N2 _ _ 755
Am't Req. PUBLIC WORKS DEPAR111�tENT
TOWN HALL
F.xr�'t on File 1540 SULLI AN AVENUEDate of ExpirationSOUTH WINDSOR, CT 06074 o.
APPLICATIO �FFOR PERMIT Permit Expires
FEE U fJ U
Name and address of applicant J a
�rlx ECx .e/ T, Phone No _S" cL
Location of proposed work
Describe fully nature of ermit requested. y
Insurance on file with Town .-
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Name of Insurer yes no Date policy expires
.a Approximate time for completion
Cal g ticket No
l before you di Desired starting ate
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A04. Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant is responsible for contacting the i licart'/J4ent a/d`�CAORE YOU DIG.
BEFORE :
.
I agree to furnish to the Town of South Windsor the amount of bond or deposit
reimburse the Town of South Windsor for any expenses incurred by the Town fir maintenance or repair
po required and to
work ,in connection with this permit and that I am f pair
regulations for permits as outlined in the Town of South dsorts (Pavement Cutwill eRe by the rules and
. S�atidns.) ..
Signe
APPROVED: DATE
Supt. of Highways OVED• S
DATE"
o n n i ter
FOR INSPECTOR: Date
work started Sufficient.notification received: yes, Date completed
no T Unusual conditions encounteredYPe of repair,: Perm: Temp.
Material slips attached: yes no Dated for ermanent. repair
Signed