HomeMy WebLinkAboutWater Street Cut Permits 141 Graham Road BOND TOWN OF 0OUTIff WINDSOR - 84
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Am TOWN HALL Date ti
�t Req. PUBLIC WORKS DEPARTMENT
t on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION PR PERMIT Permit Expires
FEE
Name and address of applicante �%"
Phone No
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town a no Date policy expires
Name of Insurer
oApproximate time for completion 's /
Desired starting. ate
go u Call before you dig ticket PJo.
A. Show sketch of proposed work or furnish 2 copies of separate drawings
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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 Regulations.)
Signed
APPROVED: DATE APPROVED: DATE
Supt. of Highways Pt�� Town Engineer .
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