HomeMy WebLinkAboutRemove approx 4 of sidewalk for telephon BOND TOWN"OF SOUTH WINDSOR N2 821 ..-
Am It Req. "LIC WORKS DEPARTMENT
TOWN HALL Date
m't on File 1540 SULLIVAN AVENUE
Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration
APPLICATION OR PERMIT permit Expires
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Name and addrijfFvjess of apple ant SNIT (20 Phone No.
Location of proposed work
Desc ibe fully nature of permit requested. -{gin i
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Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
Call before you dig ticket PJo. 77
a, Show sketch of proposed work or furnish 2 copies of separate drawings
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QApplicant 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 Wi dsor's (Pavement Cut Regulations.)
Signe
APPROVED: DATE AP RO ED• DATE -�/j c� ,
Supt. of Highways o n E eer
FOR INSPECTOR: Date work started Dane completed
Sufficient notification received: yes no Type of repair: Perm. Tem
Unusual conditions encountered P'
Material slips attached: yes no Dated for Permanent repair,
Signed
Inspector