HomeMy WebLinkAboutTelephone Street Cut Permits Graham at A BOND TOWN OF SOUTH WINDSOR � 448
Am It Req. PUBLIC WORKS DEPARTMENT
Date
It on File TOWN HALL
1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION PERMIT Permit Expires
FEE $10.00 p (r'�
Name and address of applicantf!� ff�: r; f.- /� ,
(,& Phone No.
Location of proposed work
Describe fully n�.turp of permit requested _"-
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Insurance file with Town ye sl no Date policy expires
Name of Insurer ,`r}. v�r plc.:-L
o Approximate time for completion Desired starting date Z
u Show sketch of prop
a osed work or furbish 2 copies of separate drawings
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Applicant 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 RIations.)
_ Signed
APPROVED. DATE APPROVED: -' s ?
Supt, of Highways �� ,!, r f DATE
Town ngineer
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