HomeMy WebLinkAboutWater Street Cut Permits Foster Street (2) NO 769
BOND - -
TOWN OF SOUTH WINDSOR
Am It Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
$t-on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FAR PERMIT
FEE A9 :
Name and address of applicant'.\ LX A :� l� ,��: c Phone No
}
Location of proposed work -~f F _ '. r�� ra . . 4v
Describe full nature of per it requested.
Insurance on file with Town des no Date policy expires �� : �f
Name of Insurer
o Approximate time for completion Desired starting date
Call before you dig ticket 11o.
aShow sketch of proposed work or furnish 2 copies of separate drawings
04
Cd
O
C�
4-3
04
1
.t e
U
O
i.+
�d
U
a
Applicant 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 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: % y DATE
Supt. of Highways _P4:r Town Engineer
FO'V, INSPECTOR: Date work started Date
a e completed_
Sufficient notification received: _ res no Type of repair: Perm. Temp
Unusual conditions encountered k'
Material slips attached: yes no 114ted for Permanent repair
4
S, 4A