HomeMy WebLinkAboutGas Main Street Cut Permits 2880 Ellingt BOND TOWN OF SOUTH WINDSOR N® - 789
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Am It Req. PUBLIC WORKS DEPARTMENT :a
Date
TOWN HALL
't On File 1540 SULLIVAN AVENUE Permit No.
Date of Expiration,
SOUTH WINDSOR, CT 06074
,
Permit Expires
APPLICATION FOR MIT
FEE ,
Name and address of applicant "-/ANkf '"'
Z (_,AS Phone No. 6,2,7.-
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town yes o Date olic expires
Name of Insurer -- -- p X p `f
oApproximate time for completion / �, Desired starting ate
5 Cd
Call before you dig ticket 11o. 9/3 j /gLl9
aShow sketch of proposed work or furnish 2 co ies of separate dravv'ngs
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4 Applicant is responsible for contacting the Police Department an ALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or,deposit re46ired 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 Reg+ilations.)
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Signed yL.
APPROVED: DATE APPROVED: DATE
Su t. of Highways
P , Town Engineer
�611 INSPECTOR: Date work startedPate completed
Sufficient notification received: yes no Type f repair: Perm. Tem
Unusual conditions encountered p'
Material slips attached: yes no Dated for Permanent. repair
x..
Signed
„� • aInspector e : �'