HomeMy WebLinkAboutTV cable Street Cut Permits Intersection OND T* J OF SOUTH WINDSOR N2 78
Am't Req. Cj PUBLIC WORKS DEPARTMENT . Date
TOWN HALL
!t on File v 1540 SULLIVAN AVENUE Permit No.
k "y SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name an address of applicant i�, S.(A�)e _EJc, one No.
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b�3 �(ooJ1�� ��(IN C,t Ci `-
Locat}* f prop ed work
Des The full nature of it requested.
Insurance°on file with Town yes no Date policy expires .-
Name of In urer
oApproximate time for completion . W�,e Desired starting ate
u Gall before you dig ticket 14o. 9) 3 J)
:4 Show sketch of proposed work or furnish 2 copies of separate drawings
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QApplicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
1 agree to furnish to the Town of South Windsor the amount of bond or deposit required and tb
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: &PATE Z %.
Supt. of Highways o nEfigii0er
_ _E'�OR INSPECTOR: Date -work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
-Material slips, attached: yes no Dated for Permanent -repair
Signed
Inspector