HomeMy WebLinkAboutConduit Street Cut Permits 153 to 146 Ga BOND TOWN OF SOUTH WINDSOR N 2 768
It Req. PUBLIC WORKS DEPARTMENT Date
F/ TOWN HALL
At on File SoriO, 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE --
Name and addres s of applicant
Location of\proposed work ��,► [ r„� _ 41 /s3
Desc}�ibe fully nature of permit requested. �'y ` y„<.,, 11 (1 , 1,.
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Insurance on file with Town a no Date policy expires
Name of Insurer
oApproximate time for completion Desired starting date
u Call before you dig ticket n,
Show sketch of proposed work or furnish 2 copies of separate
a drawingsa ;
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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 andregulations for permits as outlined in the Town of South Windsor's (PaLentut Regulations.)
Signed
APPROVED. DATE APPROV D: DATE
Supt. of Highways �l 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
Signed
h JEnspeetor