HomeMy WebLinkAboutSewer Installation Street Cut Permits 10 BOND TOWN OF SOUTH WINDSOR 530
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 -1\"1
Name and address of applicant f,y (-eiYSP R.
Phone No. .�� 1 R 7
Location of proposed work p
Describe fully nature of permit requested
Insurance on file with Town �yes� no Date policy expires
Name of Insurers
o Approximate time for completion f Desired starting date
U —L 19h
u Show sketch of proposed work or furnish 2 copies of separate drawings
a a s
g
�a /
w �"✓
o
O
44
„4
14 (r
O
a�
a
o
7T/i i S ?/ZC-avc y
iv EnvPe,+Vc, ray B6gTr
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
j 4 tr f
APPROVED. DATE APPROVED:
Supt. of Highways DATE_; , r
Town Engineer
FOR INSPECTOR: Date work started
Sufficient notification received: yes no T Date completed
Unusual conditions encountered Type of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector