HomeMy WebLinkAboutCut pavement, remove, repair, and regrad << ;�BOND TOWN OF SOUTH WINDSOR 543
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
to of Expiration SOUTH WINDSOR, CT 06074
APPLICAT Permit Expires
FEE $10.00 IO OR PERMIT
Name and address of applicant
'-, �� Phone No. 7 f
Location of proposed work j L,
Describe fully nature of per it requested
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Insurance on file with T wn ye.s` no Date policy expires I }
Name of Insurer
o Approximate time for completion E /, . �. =Desired starting date Y
-4 Show sketch of proposed work4or f ni sh�2 copies of separate drawings
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Applicant is responsible for contacring the Police Department an CALL BEFORE YOU DIG.
I agree to furnish to the`•T-awm-of_Sout-h- - mdsor 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 APPROVED: ' DATE
Supt. of Highways V Town Engineer
,r FOR 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