HomeMy WebLinkAboutWater Street Cut Permits 56 Beelzebub Ro h BOND TOWN OF SOUTH WINDSOR N° _ _ 718
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am It, on Idle 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION F R PERMIT
FEE
Name a d a 7� ,s of applicant 1 Phone No.
L ca on of- opo a work
Describe fully nature of permit requested. It 02
Insurance on file with Town yes no Date policy expires j
c Name of Insurer,
o Approximate time for cAmpletion esired starting date /
u Call before you dig ticket No. �� yls'Oa 7
Show sketch of proposed work or furnish 2 copies of separate drawings
04
0
Jlv
, c
0
4-3
10 0 U J
a�
04
. �
0
4-4
ell
Q 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' veme C tions.)
Signed
APPROVED: DATE APPROVED.77
Supt. of Highways -Y� Town Engineer
FO]k'INSPECTOR: Date work started Date completed 3
Sufficient notification received: yes no Type of repair: Perm, Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent_ repair
Signed
Inspector,