HomeMy WebLinkAboutWater Street Cut Permits Corneau Way 492
BOND TOWN OF SOUTH WINDSOR
Arn't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
m1t on File 1540 SULLIVAN AVENUE Permit No.
Date of .Expiration -q SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
FEE $10.00 1 1
Name and address of applicant 1)2, Phone No.
Location of proposed work z,
Describe fully nature of permit requested
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Insurance on file with Town no Date policy expires
Name of Insurer .Lk ,-,
0 Approximate time for completion Desired startin
g date
.0 Show sketch of
-prop sed work or furnish 2 copies of separate drawings
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0
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
04 1 1
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 APPJ3,0VD: DATE/,,-':)
Supt. of Highways Towri Engineer
t PR INSPECTOR: Dater work started Date completed
ficient notification received: yes no Type of repair: Perm. Temp
$U .
Ulusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector