HomeMy WebLinkAboutInstall storm drainage system Street Cut BOND TOWN OF SOUTH WINDSOR _
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't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATIO1 FID T
FEE
Name and address of applicant (Oosq, C). Phone No. U "�
Location of proposed work ) . S v�
Describe, fully nature f permit requested.
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Insurance on file with Town es no Date policy expires
c Name of Insurer
o Approximate time for completion X5�1_ Desired starting date _.
Call before you dig ticket 11o.
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:4 Show sketch, of proposed work or furnish 2 copies of separate drawings
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QApplicant 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 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.)
Signed
APPROVED. DATE APPROVED: 22:�27 DATE J-
Supt. of Highways 701�rown Enginee,� r
• FOR INSPECTOR: Date work started Da
te completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
- - - Inspector