HomeMy WebLinkAboutReplace gas service Street Cut Permits 7 N® . 763,
BOND TOWN OF SOUTH WINDSOR -
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
rna on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit E
APPLICATION FOR PERMIT xpires
FEE
NaA and address of applicant Phone No. 6-
Location of proposed work `7 fJo c w c� o ..Q
Describe fully nature of permit requested. f'c_ �� , Jr v
Insurance on file wit Town ryesa,1 no Date policy expires 1.- 11 2
Name of Insurer C i�i
.o Approximate time for completion TD A� Desired starting date 4.-1,•- /
( Call before you dig ticket No. JLL.LfJ ']
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a Show sketch of proposed work or furnish 2 copies of separate drawings
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p" Applicant is responsible for contacting the Police Dep tment'and CALL BEFORE YOU DIG.
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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 rul4s and
regulations for permits as outlined in the Tows of South Windsor's (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVED: DATE G
Supt. of Highways 10731? Town Engineer
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