HomeMy WebLinkAboutReplace culvert Street Cut Permits Ferry TOWN OF SOUTH WINDSOR 8 8
BOND - -
Am Alt R TOWN HALL
Req. PUBLIC WORKS DEPARTMENT
Dates
't on File 1540:SULLIVAN AVENUE - Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
AEPPLICATI oFO1i, PERMIT
FEE
Name and address of applicant N L � Phone No,
Location of proposed work ( N
Describe fully nature of permit requested. (7,y� �-r Pr1Gi�T
Insurance on file with Town es no Date policy expires (:)
c Name of Insurer n L,._,v Ufa NJ ,
o Approximate time for completion Desired starting ate_ /I 15
Call before you dig ticket 11o. �yo�-33 /off
aShow sketch of proposed work or furnish 2 copies of separate drawings
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c CiUL:VC�Z7" Y�c q CC=501 E1U—r (,�
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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 w abide by 'the rules and
'
regulations for permits as outlined in the Town of South Windsor's 1Pave nt Cut Regulations.)
Signed
APPROVED: DATE APPROVED— *-
DATE r'� l" ,' f
Supt. of Highways � o n peer
AND
FOR INSPECTOR: Date work started ``J 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 f,