HomeMy WebLinkAboutRoad Cut for sewer connection Street Cut ". 7",277NO
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BOND ' TOWN O SOUTH SO
WIND R �0 .
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*m't Req. .. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
xn't on File 1540`SULLIVAN AVENUE Permit No.
,.. SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATI k` FO PERMIT
FEE $10.00' .
Name ,and address of applicant 6
- Ply �/¢C�'��O �I�S7; Phone No 3 �
Location of proposed work 4,o '7 ciST�r
Describe fully natur&.of permit reque to ori
r Insurance on file with Town no Date policy expires
Name of Insurer
oApproximate time�fox completi'or Desired starting date /
Call before ticket 140. .°
Show sketch of proposed work or furnish 2 copies of separate drawinas
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44
04
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Applicant is responsible for contacting the Police Departmetlt and CALL BEFORE YOU DIG.
I agree to furnish to the'l 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 Awith1dwill a ' by the rules and
regulations fot,permits as outlined m the 'own bf South Win en' .Cut egulations.)(„�
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Signed
APPROVED:', DATE APP OV_ - ATEg�¢�
Stet. of ighvvars � — o _n eer ,
;Y
FOR I1 SPEGTAR: DatewwQrk)stosrted Date completed
Y _ .Suffi.cunt,notifioaton x-e<ce�vd:_ ---yes no- Type of repairs Perm. Temp:- -
Unusual`condition's encountered
Material slips attached: yes no Di tell for Permanent repair
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