HomeMy WebLinkAboutWater Street Cut Permits 250 Foster Road BOND TOWN OF SOUTH WINDSOR
Am't Date
Req. PUBLIC WORKS DEPARTMENT /� -- ` - U/
TOWN HALL
m't on File 1540 SULLIVAN AVENUE
Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00 �r
Name and address of applicant C,L t' i~f.s` C(� . Phone No, lS
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town yes Z70 no Date policy expires
Name 0f Insurer
oApproximate time for completion a.. JD e" Z ,5 Desired starting date /,a
Call before 'you dig ticket 14c
U
Show .ske.tch of proposed work or furnish 2 copies of separate drawings
O
N
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a / �► 1
0
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04
Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. "t �
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 iri 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 APPROV ➢ r
Su t, of Highways "` DATE f✓
PTown Eii, iri:eer
FOR IN91PECTO�R: Date work sta:nted Date completed
Sufficient notification receive'd '. yes no, ''-Type of repair: Perm. Temp.
Unusual conditions:enco'u-nte jr-EX.
Material slips attached:' yes ''' .no Dated for Permanent repair
Signed
Inspector