HomeMy WebLinkAboutDriveway Street Cut Permits 1774 Ellingt t _
BAND TOWN OF SOUTH WINDSOR
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Am�t Req. PUBLIC WORKS-.-DEPARTMENT Date
TOWN HALT.
;Amtt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH,WINDSOR, CT 06074
Date of E3cpiration Permit E4ires
APPLICATIOR PERMIT
( FEE $10.00
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Name and address of applicant '4- 2 Phone No. �`� �
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t Location`"of proposed. work
Describe fully nature of permit request d
Insurance on file w'th Town yes no Date policy expires
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Name of Insurer
Approximate timecr completion ti.� 5 Desired stgtjg date Q
Call before you dig ticket r1o. ZS�j�3?( } t� -r r
w' Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicanris responsible for contacting the Police Department and CALL BEFORE YOU DIG.
-I -agr"L to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimb6rse 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 & �t
APPROVED: DATE APPROVED:,' "o >
Supt, of Rijhways Town Engineer
FOR INSPECTOR: D a work, started Date completed
Sufficient notification received: yes -7 no Type of-repair: Perm. Temp:
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Unusual conditions encountered
Material slips attached: yes. no Dated for Permanent repair
Si��ne d
Inspector