HomeMy WebLinkAboutWater Street Cut Permits 57 Beelzebub Ro No 724
BOND TOWN OF SOUTH WINDSOR "
Am,,VReq. PUBLIC W RKS DEPARTMENT Date
a TOWN HALL
Vk-mlt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FWR PERMIT
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Na an add s o p 'cant Phone No. �
n of Pr6pos-ed work
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Describe fully nature of permit requested. /
Insurance on file wi Town ��re ' xio Date policy expires
Name of Insurer
oApproximate time forgompletion y. ,p Desired starting ate
Call before you dig ticket 11o. '—
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a Show sketch of proposed work or furnish 2 copies of separate drawings
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QApplicant is responsible for contacting the Police Depart ent and CALL BEFORE Y U 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 abfde by 'the rules and
regulations for permits as outlined in the Town of South Win pr's ,�vement Cut t' ns.j
Signe
APPROVED. DATE AP ROVED: DATE
Supt. of Highways To n ngineer ,
FOR INSPECTOR: Date work started u
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
spector