HomeMy WebLinkAboutStreet Cut Permits Clark Street BOND TOWN OF SOUTH W INDSOR _ 61
Am'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
FEE "—
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ame ancl addresjs of ap cant
Phone No. <� i
Location of proposed work
Describe fully nature of permit requested 77 r7 ,t
Insurance on file wit l �Trn ye Jno Date policy expires
Name of Insurer < = �.;f;
o Approximate time for c O m letion
PP p Desired starting date - c
Call before you dig ticket Poo.
aShow sketc of proposed work or furnish 2 copies of separate drawings
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14
04
41
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QApplicant 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.)
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APPROVED: DATE APPROVED: DATE =� '
Supt. of Highways o g er
FOR INSPECTOR: Date work started Date completed _
Sdf icient notification received: yes no Type of repair: Perm. Ted .
Unusual conditions encountered
. _Material slips attached: yes no Dated for Permanent- repair -
Signed
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