HomeMy WebLinkAboutWater Street Cut Permits 120 Foster Road (2) "z2W
`BOND N.. 827
TOWN OF SOUTH WINDSOR -
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Req. PUB- C WORKS DEPARTMENT Date
TOWN HALL
n File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
f Expiration Permit Expires
APPLICATION OR ERMIT
FEE ' \
Name and address of'applican&V S-JA1F Phone No. cy-) ���
Location of proposed work 1 - c) S k
Describe fully
(nature of permit requested. JFj
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Insurance on file with Town yes no, Date policy expires
>~ Name of Insurer '�"
o Approximate time for completion 9 esire'd starting date G
' a Call before you dig ticket 14o. v __
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4 Show sketch of proposed work or furnish 2 copies of separate drawings
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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 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: Gl j/ DATE
Supt. of Highways Town Engineer
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
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