HomeMy WebLinkAboutRepair broken water service Street Cut P (2) BOND TOWN OF SOUTH WINDSOR N2 750
Am It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
m't on File 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant yt, C T - t- Phone No, G Z
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Location of proposed
Describe fully nature of per requested
Insurance on file with Town yes_-) no Date policy expires
Name of Insurer 1
o Approximate time for completion r9.o� Des g ired staxtin ate
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u Call before you dig ticket TJo.
aShow sketch of proposed work or furnish 2 copies of separate d
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Q 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 Tu�*n for maintenance or repair
work in connection with this permit and that I am familiar with and
regulations for � ( ?yvi11 abide by :the rules and
permits as outlined in the Town of South Windsor's Pavement Cut Regulations.)
Signed
APPROVED: DATE APPRbVED:_�j �< DATE
Supt, of Highways
Town Engineer
FOR IN a
SPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: .Perm. � Temp.Unusual conditions encountered_
Material slips attached: yes no Dated for Perrhanent repair
Signed
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