HomeMy WebLinkAboutWater Street Cut Permits Clark Street BOND_ TOWN OF SOUTH WINDSOR 522
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
Am
't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant
r :� Phone No. `_"- C
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town yes f no Date policy expires Name of Insurer _�f: j
o Approximate time forr completion r - /
Desired starting date 3 n
.� Show sketch of proposed work or furnish 2 copies of separate drawings
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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 J r,
APPROVED: DATE
APPROVED: ,y DATE
Supt, of Highways
/7 Town ngineer
FOR INSPECTOR: Date work started
Sufficient- _no es notification received: Date completed _
y Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector