HomeMy WebLinkAboutRoad widening Street Cut Permits Dart Hi BOND TOWN Or,SOUTH WINDSOR N
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
-Date of Expiration Permit Expires
APPLICATIO MIT
FEE
Name and address of applicant -? ' -��' Via^"S T Phone No.
Location of proposed work 75A 72-r t-t r l cU tv
Describe fully nature of permit requested. O A D JP,w
Insurance on file with Town a no Date policy expires
Name of Insurer
o Approximate time for completion Z w,G I Desired starting date y
u Call before you dig ticket PJo. 9 2- 171 4I 0 6
a Show sketch of proposed work or furnish 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 (Pavement Cut Regulations.)
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Signed
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APPROVED: DATE APPROVED:
Su t of Hi -
p . ghways 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