HomeMy WebLinkAboutExtend sewer Street Cut Permits Dart Hil BOND TOWN OF,.SOUTH WINDSOR
Am't Req. PUBLICOWORKS DEPAR1114ENT Date
TOWN HALL
m't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH_ WINDSOR,CT 06074
Date of Expiration Permit Expires
APPLICATIO F �i, ,PERIVIT
FEE
Name and address of applicant ! M j °~' Phone No. c /
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Location of proposed work _D/9 rl i_ r-ri 1 s s i,; > 7
Describe fully nature of permit requested: t
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion ( D R`/ Desired starting da
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Call before you dig ticket No. ¢j Z Z q 2
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Show sketch of proposed work or furnish 2 copies of separate drawings
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4 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.)
Signed
APPROVED. DATE APPROVED: DATE'
Supt. o Highways Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient noti ication received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector