HomeMy WebLinkAboutTelephone Street Cut Permits 56 Deerfiel BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT
Date
Am't on File TOWN HALL1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATION OR PERMIT Permit Expires
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FEE $10.00 " F`
Name and address of applicant- Phone No
Location of proposed work
Describe fully nature of permit requested
Insurance on`file ewith Town yes no Date policy expires .f
Name of Insurer {�
oApproximate time for completion Desired starting date
Show sketch of proposed work or furnish 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's (Pavement Cut Regulations.)
i
Signed
APPROVED: DATE APPROVED: DATE
'2;1 ;
Supt. of Highways7�
Town Engineer
FOR INSPECTOR: Date. work started Date completed
Sufficient notification received: yes no Type of repair: Per
Unusual conditions encountered y p m• Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector