HomeMy WebLinkAboutGas Main Street Cut Permits 135 Graham R BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
It on File 1W SULLIVAN-AVENUE - -
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATION FOR, PERMIT Permit Expires
Name and address of applicant „� Phone No.
Location of propp§ed work F- ,
Describe fully nature of permit requested.
Insurance on file with Town yes no Date policy expires
c Name of Insurer :),. -� ; ,-,
o Approximate time for a�b pletion_ �y� �, _Desired starting date �LL,; ;
u Call before you dig ticket iJo.
aShow sketch of proposed work or furnish 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
work in connection with this permit and that I am familiar with and or repair
abide by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed r ` .� Or :�,;;.Pr y `4 K •.
APPROVED: DATE APPROVE40 -
IL DATE �/� ' ,• =-
Supt. of Highways n E
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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