HomeMy WebLinkAboutGas Service Street Cut Permits 141 Graha BOND TOWN OF SOUTH WINDSOR NE 054
Am It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
Am't on File 1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074 Permit No.
-Date of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant
Phone No
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town yes no Date policy expires
o Name of Insurer - -
o Approximate time for completion�j , / �, Desired starting ate ;;c
Call before you dig ticket Pdo. �``
a. Show sketch of proposed work or furnish 2 copies of separate drawings ---_~
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QI Applicant is responsible for contacting t Police Department .nd 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 Regulations.)
Signed
- -g
APPROVED: DATE APPROVED: 'l
Supt. of Highways , � ' DATE(.
6 Town. Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: ayes no Type of repair: Perm. __ e�—
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector