HomeMy WebLinkAboutWater Street Cut Permits Avery Street pu BOND TOWN OF SOUTH WINDSOR 44U
Am't Req. 6 000 PUBLIC WORKS DEPARTMENT
Date a_ 7 -87
TOWN HALL
It on File z o Uc>U 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
ate of Expiration Permit E fires u
i3� ' ►-;p s APPLICATION FOR PERMIT j
FEE $10.00
Name and address of applicant-Tt V,
Phone No. 5 .� 7- 01 y 7
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Location of proposed work
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Describe fully nature of permit requested , h� 4u -� �
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Insurance on file with Town es no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
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.4 Show sketch of proposed work or furnish 2 copies of separate drawings
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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 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� � l -
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APPROVED. DATE APPROVED: / ��1�:. ATE 7-G'7
Supt. of Highways Town Engineer
TOR INSPECTOR: Date work started Date completed
es no
Sufficient notification received: T p
y ype of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector