HomeMy WebLinkAboutConnect to catch basin Street Cut Permit BOND TOWN OF SOUTH WINDSOR N2 643
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FQR PERMIT
FEE $10.00 - ' 1 �� . �k(,C-
Name and address of applicant —22K2 i e 2" fyS J, 69 INr Phone No b If f 66)6?7
L ,S7oC K �l_i9C�' /Y)n/V,1M PJ7r f2 ` r 1-
Location of proposed work I-C,,,; Q Mr /-ey21
Describe fully nature of permit requested C"b"/V(1c i
Insurance on file with Town \yes;, no Date policy expires
Name of Insurer
o Approximate time for completion 2- ��9y Desired starting date _. g
u Call before you dig ticket 11o. Ig•I y 6 O Y 9
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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 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 ( ement Cut Regulation )
Signed Aell14
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APPROVED. DATE APPROVED• DATE
Supt. of Highways 'own eer
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f 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