HomeMy WebLinkAboutCAble Street Cut Permits 100-124 Gray Ro r7 z-r -e :t•.•.r�•,�?t n E„ . s
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A -AO NDNO
,TOWN OF SOUTH WINDSOR
Am't Peg• �' PUBLIC WORKS DEPARTMENT
Date,
'>F on File TOWN HALL
r 1540 SULLIVAN AVENUE Permit No.
n $OUTH WINDSOR, CT 06074
k ',)Dote :of Exp ration
APPLIC�AI► N F R PERMIT Permit"Expires
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FEE $10.00 i
Name and, address of applicant 2S. Phone No.
d afi6n of ,roposed war °
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o
Describe fully ;nature of permit requested
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P= -
n Insurance on ile with Town yes no Ba11 t policy expires
Name of Insurer --
vo
App,roximate time_ fox completion y � sired stiatii}g date ,g"»
Call before you di,g t3 Cket Teo.
� .
Show sketch of proposed work or furnish 2--copies of se parate drawings
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Rd
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�! App!ieant is responsible for contacting the Police ' artment'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 wore 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 ! v!
APPROVED:
DATE APPROV
DATE '! 7
Supt. o Highways To n- i eer
POR Ih1SPECTOR: Date-work started _
Date completed
,� . ..}_ _ '._ok
uffic .ent notf�eatiori received: yers n� Type of repair:
ere f
;Material slips ttached: yes no Dated for Permanent xepair --r
r � -- - -- - -
Signed