HomeMy WebLinkAboutWater Street Cut Permits 125 Burgess Roa NO : - 7071_
BOND TOWN OF SOUTH WINDSOR -
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
'ntt on File«- 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATIO FO I? MI
FEE , J
Name and address of applicant w Phone No.J�
Location of proposed work 7C'
Describe fully nature of permit requested. r
Insutlan:ce on file with Town yes ., no Date policy expires
Name of Insurer
oApproximate time for completion I i) 1�) - Desired starting tee t
Call before you dig ticket No. �1(}L{ 1 y
-4 Show sketch of proposed work or furnish 2 copies of separate dra*fr igs
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QApp lip 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, t.
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 1 am familiar with and will abide by the rutleii and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cat Regulations.)
Signed�
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APPROVED. DATE APPROVED: DATE
Supt. of Highways 7261�Town Engineer T
FOR INSPECTOR: Date work started_ Date completed
_ ---. pleted
`V6- _yes no ype of repair. Perm. Ternp. -
_-- Sufficient noti ication'received
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector' ,