HomeMy WebLinkAboutGas Service Street Cut Permits 16, 32, 7 Jo 42�
BOND TOWN OF SOUTH WINDSOR
Am It Req. PUBLIC WORKS DEPARTMENT Date x� Y;
�) TOWN HALL -
t on File ��' 1540 SULLIVAN AVENUE
Permit No.
SOUTH WINDSOR CT 06074
Date of Expiration f,��. Ff.,, ;
APPLICATION .FOR PERMIT Permit Expires
FEE $10.00 ,v/f'
Name and address of applicant i',
¢✓ Phone No. Z?- 2
Location of proposed work -r
/dam
Describe fully nature of permit requested
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Insurance on file with Town _ yes no Date policy expires
� Name of Insurer -"
o Approximate time for completion Z ired starting date r
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Show sketch of proposed work or furnish 2 copies of separate drawings
o
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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 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.)
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APPROVED: DATE APPROVED: „ f r.
u t. of-Highways r? TE
S
PTown`Engineer
J I C7- C. elf,jAl r
FOR INSPECTOR: Date. work started Date completed
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Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual, conditions encountered
_Material slips attached: yes no Dated for Permanent repair
Signed
Inspector