HomeMy WebLinkAboutWater Street Cut Permits 432 Foster Road w �
B I�2 ' 77;3OND TOWN OF SOUTH WINDSOR -
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
on File IW SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
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Name and address of applic nt ~� 5r Phone No. L
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Location of prop ed work Z Fc,
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Describe fully nature of permit requested. eXG4 ve,A �vn
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assurance on file wit own n es no Date policy expires 2
Name of Insurer �'_ nc� �., ie t C(:,SU"l Y,
o Approximate time for completion c,N/ Desired starting ate �� 1
Call before you dig ticket Poo. —'-7`—
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aShow 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: ATE Vw
Supt. of Highways o En i er
FOR INSPECTOR: Date work started Date completed
ufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
�sr�edtor .