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HomeMy WebLinkAboutRoad widening Street Cut Permits Ellingt a': BOND TOWN OF SOUTH WINDSOR 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 APPLICAT FEE $10.00 PEERMIT 'V Name and address of applicant ,L Q IC501�ui Phone No 3- 365/ Location of proposed work 7 /Cal � : ,Cie. 0{ (2©c'CL /- ar. '1 ss escribe fully nature of pe-^r»m--it requested 12,,,� INN i Insurance on file with Town dye no Date policy expires .J unP 3CD 1993 Name of Insurer 0 Approximate time for completion �; � Desired starting date Jr,j�, Show sketch of proposed work or furnish 2 copies of separate drawings a k O uas a) V a o_ U O 4b 44 U 04 Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. a 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.) Signed APPROVED. DATE APPROVE DATEIlk 3© Supt. of Highways To n neer 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