HomeMy WebLinkAboutCurb Cut for driveway Street Cut Permits (2) BOND TOWN OF SOUTH WINDSOR --
Am't Req. PUBLIC`-WORKS DEPARTMENT Date
TOWN HALL
_ m't on File 1540'SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLIC,JION FOR PERMIT
FEES�� _
Name and address of applicants j h $ �, Phone No. Z gb
Location of proposed work o
Describe fully nature of permit requested. 22
Insurance on file ith Town yes no Date policy expires
Name of Insurer '' '
o Approximate time for completion / �p y Desired starting ate
a Call before you dig ticket' No.
v
404
Show sketch of proposed work or furnish 2 copies of separate drawings
a
0
0
a
W-4
a�
0
a
0
u
0
44
u
a
Applicpnt is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agr a to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimbu a 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 ref South Windsor's (Pavement Cut Regulations.)
Signed
APPROVED. DATE APPROVED: DATE I`'Supt. of Highways o veer
FOR INSPECTOR: Date work started Date P coin leted
'Sufficient noti ration received: yes no Type of repco Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
speator .