HomeMy WebLinkAboutRepair drainage to SNET phone cable Stre -- BOND TOWN OF SOUTH WINDSOR N° _ 711
Am It Req. PUBLIC WORKS DEPAR
T Date
� It on File,�; TOWN HALL,. 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant
Phone No.
Locati n of proposed work ol
r
Describe fully nature of permit requested.
Insurance on file with Town yes no Date policy expires
c Name of Insurer
o Approximate time for completion
'" esired starting Call before you dig ticket 140.
�3 '•c.�c� A r-�
a Show sketch of proposed work or furnish 2 copies of separate n s
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Q 1Applicant 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 q"wired and to
reimburse or deposit r
the Town of South Windsor for any expenses incurred by the or
for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by :the, rules and ,
regulstidns for permits as outlined in the,Town of South Windsor's (Pavement Cut Re r gt&tign�s.
Signed
APPROVED. DATE APPROVED: '"'
Supt.of Highways �+ at ,.K_DATE r
Town Engineer
FORtikSPECTOR: Date work started
Su ficient noti ication received: yes, no T a Date epmpleted
Unusual conditions encountered YP of repair: Perm.--`" ee —'
Material slips attached: yes no aced for Permanent repair
Signed
.. InspeVtor