HomeMy WebLinkAboutWater Street Cut Permits Griffin and Win r ,fir fit" 4+ ,`
N? 573
BOND TOWN OF SOUTH WINDSOR
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 FOR PERMIT
FEE $10.00
Name and address of applicant Phone No
Location of proposed work
Describe fully nature of permit requested /U (�
Insurance on file with Town <jyep no Date policy expires 1 y
Name of Insurer C- --
o Approximate time for completion -� ' r , �.,f; Desired starting date --,
Show sketch of proposed work or furn sh 2 copies of separate drawings
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¢' Applicant is responsible for contactin the Police Departm nt and CALL BEFORE YOU DIG.
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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: j7 DATE '%r=
Supt. of Highways > 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