HomeMy WebLinkAboutSewer Extension Street Cut Permits Lot 2 $OND N2
TOWN OF SOUTH WINDSOR
eq. PUBLIC WORDS "DIMiMl ENT Date
TOWN-HALL
It on File
1540'SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date-'of Lxpt:ration
Permit Expires
-APPLICATION FOR PERMIT -
FILE $10,00
Name and add re s of�yt'1 pl.ica.nt V r" "s Cf` s N Phone
., Location'o --propose, work e. •�, �•• Y
esc ibe fµllp natu of permit requested
Insurance on file with Town e no Date policy expires
Name of Insurer
Approximate time completion. Desired starting date
' Call before you di" ticket Pdo.
Show sketch of proposedlwork or furnish 2 copies of separate drawings
Lo
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.,
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aV
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Applicant isrresponsible 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
rehulN arse-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 lations
Signed ;0V
APPROVED: DATE APPROVED: DATE
x Supt, of Highways ? -Engineer ----r-`_
GK
'OR.:INSPECTOR: Date.work started Date completed
.-=Sufficient_-notification received: yes no- Type of repair: Perm'. Teti—p Y
encountered-
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector.