HomeMy WebLinkAboutWater Street Cut Permits Foster Street BOND TOWN OF SOUTH WINDSOR NO - 741
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
mtt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 00074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE � "
Name and address of applicant -Y-t--lU C 7 (,.�ATtR CC Phone No GZ7 7 _; y
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Location of proposed work T. Cr I F
Describe fully nature of permit requested. �1� T;q LL 1 �a r F:
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Insurance on file with Town CJres no Date policy expires
Name of Insurer
oApproximate time for completion i Desired starting date
Call before you dig ticket 11o. l t - i Z`t Z3
aShow sketch of proposed work or urnish 2 copies of separate drawings
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QApplicant is responsible for contacting the Police Department and CALL BEF RErtC�YOU DIG.
I agree to furnish to tithe 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 APPROVED: DATE
Supt. of Highways Pr/-"Town Engineer
FOR INSPECTOR: Date work started Date completed,„ .
Sufficient noti ication received: yes no Type of repair: Perm.— Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
s3pector