HomeMy WebLinkAboutWater Street Cut Permits 995 Foster Stre 745
'BOND TOWN OF SOUTH WINDSOR "
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PER1][IT
FEE
Name' and address of applicant _, - k, - o,., i.,( Phone No. E-7_5 11 .:2
Location of proposed work 9's, ! o-Jr, Sa c-- r
Describe fully nature of permit requested. o /I
Insurance on file with Town Yes_--- no Date policy expires
Name of Insurer i_i ;. )
o Approximate time for completion � ; ��, Desired starting ate 4 �9 )
Ca11 before you dig ticket No. 4 6
14
.� 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 rattles and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed / !A
APPROVED: DATE APPROVED: 3/ DATE
Supt. of Highways Town Engineer .
7
mr, 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,