HomeMy WebLinkAboutRepair water main Street Cut Permits Blu TOWN OF SOUTH WINDSOR N0 738
BOND
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't,,on File 1540 SULLIVAN AVENUE Permit No. A
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE a/®�-
Name and address of applicant -:6, C T- C \_c,_+ Phone No.
Co .
Location of proposed work
Describe fully nature of permit requested: ,
Insurance on file, with Town es no Date policy expires
Name of Insurer
. a Approximate time for completions _Desired starting date Z - t c, - i
Call before you dig ticket No. cq l d
4 Show sketch of proposed work or furnish 2 copies of separate drawings
04
14
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4.
QApplicant is res nsible 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 j
APPROVED: DATE APPROVED: DATE Z_
Supt. of Highways Town Engineer
:-- 'MR INSPECTOR: Date work started Date completed
Suff client notification received:. yes no ype of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for,Permanent repair
Signed.
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