HomeMy WebLinkAboutWidening of Newmarker Road up Debbie Dri BOND
TOWN OF SOUTH WINDSOR 378
8
Am't Req _ �6 PUBLIC WORKS DEPARTMENT
• T TOWN HALL Date
on File v 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of .Expiration/i� 6t� Permit.Expires
APPLICATION FOR PERMIT
FEE $10.00
Name and address of applicant
�.�. M Phone No
Location of proposed work
Describe fully nature of-permit requested 1.s. -
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Insurance on file with-. - y no Date policy expires
Name of Insurer
o Approximate time for completionsi;edstaYting date
cd _.
u Show sketch of proposed work .or--furni'sh 2-copies of separate drawings
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
work in connection ,with this permit and that I am familiar with and will abide by the.,rules and
regulations for permits as outlined in the Town of South Windsor P-,Pv$ement Cut Regul "ons.)
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X Signed
APPROVED: DATE
APPROVED: :• - �, � 7, r� ;,,
Supt. of Highways Town En in�
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
Inspector