HomeMy WebLinkAboutGas Main Street Cut Permits 670 Avery St 497
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBL'1C WORKS DEPARTMENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
ate of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00
Name and address of applicant EL* P Phone No
Location of proposed work -
Describe fullynature of permit requested F- <c,4 VA-rF- i,y c
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Insurance on file with Town no Date policy expires
Name of Insurer
Approximate time for completion Desired starting date 4_
Show sketch of proposed work or furnish 2 copies of separate drawings
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a Applicant is responsible for contacting the Police Department and CALL BEF RE YOU DIG.
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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 ' 1
APPROVED. DATE APPROVED: DATE
Supt. of Highways Towri En r eer
• FOR INSPECTOR: 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 Permanent repair
Signed
Inspector