HomeMy WebLinkAboutSewer Installation Street Cut Permits Da (2) aoND TOWN OF S016 '
TH ` VINDSOR ,
't Req._ PUBLIC WaI S••DEPARTMENT
Date
TOWN HALL
It on File ,C.f 1540 SULLIVAN AVENUE
Permit
SOUTH WINDSOR, CT 06074.
s Date of Expiration
APPI�ICATI N F R PERMIT Permit Expires
FEE $10.00 t
Name and address of applicant Phone
Location of proposeftporArf
k' i
Describe fully nature of permit requested
g . Insurance on file with Town es no Date policy expires
Name of Insurer
... Approximate time completion ,�-r s Desired starting date
�t.
Call before you did.:trcket 11o.
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Al Show, sketch of proposed w rk or furnish 2 c pies of separate. drawintA Ad,
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Applicant is
tFf 340�responsible for contacting the Police 10 partment.and CALL BEFORE YOU DIG.
,h 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 Tows} for intenance or repair
Work in connection with this�permit and thaat I am. familiar with and abi by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pav Regulations.)
Signed4A Al'
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APPROVED: DATE APPROVE : ATE J
Supt. of Highways o n n i r
FOR INSPECTOR: Date work started
�jDaCe`corrfpleted
Sufficient notification received yes no ype of repair: Perm.
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Temp.
. Unus- -Bond+ t ons en cvurxte - -- --__-- •_- ._-_--
Material slips attached: yes no ated for Permanent repair
I:Signed
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