HomeMy WebLinkAboutWater Street Cut Permits 112 Beelzebub R t.
BOND TOWN N° - - 722
OF SOUTH WINDSOR
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q. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
(Am-!ton File 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiraon
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant Phone No. loos
d YYV SI.All
Location of proposed work /
Describe fully nature of permit requested.
Insurance on file with own no Date policy expires /
_-- _
� Name of Insurer
o Approximate time for completion Desired starting datte
u Call before you dig ticket 11o. �
S ow 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 require4 and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance_ `nr 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
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APPROVED: DATE APPR VED. 9zrnu DATE / �/
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started
Sufficient.notification'received: es no Date completed
y Type of repair: Perm..`Temp,
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
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