HomeMy WebLinkAboutPipe excavation and backfilling, pave St ��A P BOND TOWN OF SOUTH WINDSOR 523
Am'tof Expiration Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL
Am't on File 1540 SULLIVAN AVENUE
Permit No.
Date
SOUTH WINDSOR, CT 06074
APPLICATIO FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant phone No G yy
Location of proposed work r
Describe fully nature of permit requestedCYC
Insurance on file with Town y no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
Cd
.11 Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant is responsible for contacting the Police Department). d CALL BEFORE YOU DIG.�
I agree to furnish to the Town of'South Windsor theyainount' 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 (Paveme t Cut Regulations.)
Signed
APPROVED: DATE APPROVED: , DATE .�
Su t. of Hi hwa s'. {'
p g y. "�?�, Town' ngineer
FOR INSPECTOR: Date. wgxrk 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