HomeMy WebLinkAboutWater Street Cut Permits Ayers Road (2) -- BOND TOWN OF SOUTH WINDSOR N° _ - 744.
Am't Req. PUBLIC WORKS DEPARTMENT Date
10 TOWN HALL
"It on File 1540 SULLIVAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074 �
.Permit Expires
APPLICATION FOR PERMIT
FEES""
Name and address ofapplicant C T Phon.eNo.
71 i C - _ -
Location of proposed work
Describe fully nature of permit requested. T( -r 1-,1`, r A 1pa ' of
#� t���. T E G• 1 F i N To
Insurance on file with Town yes no Date policy expires
Name of Insurer -
.0 Approximate time for completion 5 Desired starting date
Call before you dig ticket i4o.
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4 Show sketch of proposed work or furnish 2 copies of separate drawings
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Q Appli�ani 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: DATE p `�/`
ca ..�
Supt. of Highways ' Town Engineer
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 ,°