HomeMy WebLinkAboutCAble Street Cut Permits Deming Street a BOND TOWN OF SOUTH WINDSOR ® 895
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION F(�R PERMIT
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Name and address of applicant � T��fRs,'��`-u7s�. �� •� Phone No.
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Location of proposed work_ )Fmiu� 'zd A-} 04—zr,�ju; a �ckt'A«t
Describe fully nature of permit requested. T;as;n t. -7 i �L , CAT
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Insurance on file with Town Qye no Date policy expires S- 31.V
Name of Insurer 7—ei i: Nn,2Tr-7o
oApproximate time for completion / Wry.�� Desired starting date lo,I J. L
Call before you dig ticket P1o.
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Show sketch of proposed work orJurnish 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 Windso 's (Pavement Cut .Regulations.)
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Signed
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APPROVED: DATE APPROVED.:- '' >,4Y DATE]
Supt. of Highways YTown Efi4ineer
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
IFs ector ��