HomeMy WebLinkAboutInstallation of utilities Street Cut Per BOND ✓
TOWN~OF SOUTH WINDSOR N o - 739
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
It'von File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION .F MIZ. Permit Expires
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FEE 0/(,
Name and address of applicant Bluestone Contractors, Inc. Phone No. 203-676-1066
Location of proposed work _ ,+
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Describe fully nature of permit requested. --T i
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Insurance on file with Town ye no Date policy expires
c Name of Insurer
o Approximate time for completion Desired starting date
u Call before You dig ticket 14o.
04
Show sketch of proposed work or furnish 2 copies of separate drawin s
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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 Re�ulations.)
Thomas Reardon, PresTfent ',
Signed r ,
APPROVED: DATE
APPROVED:
Supt. of Highways - DATE 3,--V4 7
T2!%-" Town Engineer
FOR INSPECTOR: Date work started
Sufficient notii ication received: es no T Date completed
Unusual conditions encountered Y Type of repair: Perm. Temp.
h4aterial slips attached: yes no Dated for 'Permanent repair
Signed
7aispector