HomeMy WebLinkAboutWater Street Cut Permits 60 Foster Stree pro 5 83
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
mIt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATI�Q�T FOR PERMIT
FEE $10.00
Name and address of applicant i_) Phone No. Y �
Location of proposed work t.
Describe fully nature of permit requested 7 ...r--
Insurance on file with Town es no Date policy expires
c Name of Insurer '
O Approximate time for completion 1; ' Desired starting date a ; ' j,
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.4 Show sketch of proposed work or furnish 2 copies of separate drawings
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¢' Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
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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 Ithe rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Chi Re lations.)
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Signed
APPROVED. , ` --_;ATE APPROVE : 5,-Z�,,f TE
Supt. of Highways j2 r> Town Engineer `
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FOR INSPECTOR: Date work started 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