HomeMy WebLinkAboutStreet Cut Permits Benedict Drive BOND TOWN OF SOUTH WINDSOR - -
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
,in't on File 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant �r, ,
C . Phone No.
Location of proposed work,,
Describe fully r
Describe ..a,.4�� .,� Yermi[ requested
Insurance on file with Town ffsno Date policy expiresName of Insurer
oApproximate time for completion [de:�Erz. Desired starting date r
u cc.Call before you dig ticket ido. '9��� — /' z
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Show sketch of proposed work or furnish 2 copies of separate drawings
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QApplicant 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: ✓ f���Supt. of Highways DAT F&-/ <-
/� Town Engineer
FOR INSPECTOR: Date work started J` Date completed
Sufficient-notification received: yes no Type of repaiv Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector