HomeMy WebLinkAboutStreet Cut Permit Abbe Road/Coven Mounta BOND TOWN OF SOUTH WINDSOR
Am't Req. 'PUBLIC WORKS DEPARTMENT
TOWN HALL Date
Am't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00 ';; i
Name and address of applicant t s
Phone No./�'
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town yes no Date policy expires
Name of Insurer
O Approximate time for completion
d 6,, Call before you dig ticket i1o. Desired starting date
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0 Show sketch of proposed work or furnish 2 copies of separate drawin
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
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
by the rule
regulations for permits as outlined in the Town of South Windsor's (Pavement Cute Regulations.)s and
Signed
APPROVED: DATE APPROVED:
Supt. of Hi „," DATE Highways Town Engineer
. FOR INSPECTOR: Date work started
Sufficient notification received: yes no T Date completed
Unusual conditions encountered YPe of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector