HomeMy WebLinkAboutSewer Installation Street Cut Permits Da (4) ';� ...BOND TOWN OF SOUTH WINDSOR 532
Am't Req. PUBLIC WORKS DEPARTMENT Date
m't on File TOWN HALL1540 SULLIVAN AVENUE
Permit No.
to of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant �/`j� �pjt1S-- KO 11W6ne No Gt� �87
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Location of proposed work �P ��I ae /?Ds4�
Describe fully nature of permit requested .SpK,e,� 14lSTr41 p-,o.�J
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Insurance on file with own . es no Daxpires
Name of Insurer
o Approximate time for completion Desired starting date
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Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant 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 ement Cut Regul ions.
Signed
APPROVED. DATE APPROVED:_ r� �
DATE
Supt. of Highways Town Engineer
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