HomeMy WebLinkAboutStorm sewers Street Cut Permits Betty Dr BOND TOWN OF SOUTH WINDSOR y
Am It Req. PUBLIC WORKS DEPARTMENT
Da
TOWN HALL Date
Am't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICAT T FOR P.+ I�MIT Permit Expire$
FEE $10.00 �' !cJi
Name and address of applicant
1 i-1 lr X- Phone No C
i
S
Location of proposed work
Describe
// fully nature of permit requ ested j {:
r Y!
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
itt
Show sketch of proposed work or furnish 2 copies of separate drawings
a s g
ae
w
O 1
O
4
$4
O
X
+'
O
U
O
4+
Cd H.
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 im 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: �! l� DATE -
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