HomeMy WebLinkAboutDriveway Street Cut Permits Lot 27 Cambr BOND TOWN OF SOUTH WINDSOR $$9
Am It Req. PUBLIC WORKS DEPARTMENT Date y ��
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATI N, OR RMIT
FEE 1- -- /
Name and address of applicant, �� c C1 1' Phone No. �yf( 6/
Location of proposed work O
Describe fully nature of permit requested.
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Insurance on file with Town es; no Date policy expires
Name of Insurer j
.co. Approximate tim for completion Desired starting ats2
u Call before you dig ticket i1o: j
Show sketch of proposed work'or furnish 2 copies of separat
a e drawings
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p' Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
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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: DATE
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started Date completed ___.___
Sufficient notification- yp
received: yes no Te of repair: Perm. emp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector