HomeMy WebLinkAboutDriveway Street Cut Permits Lot 54 Carso BOND TOWN OF SOUTH WINDSOR, 0920
Ain't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE
Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
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FEE
Name and address of applicant Phone No
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town es ' . .no ate policy expires
a Name of Insurer s -r
0 Approximate time or completion ,' t'1, t; Desired starting date
10
Call before you dig ticket rio.
U
Show sketch of proposed work or furnish 2 copies of separate drawings
a
a
0
c
0
_0
y
as
i
a
0
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0
OSHA REQUIREMENTS MUST BE FOLLOWED
a
4 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 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: `'
�`DAT E
Supt. of Highways 7,/_; 'Town Engineer
FOR INSPECTOR: Date work started Date o c mpleted
u ficient noti ication received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for ermanent repair
Signed
Inspector