HomeMy WebLinkAboutDrainage Street Cut Permits 80 Hayes Roa BOND TOWN OF SOUTH WINDSOR 790
<_ Am't Req. PUBLIC WORKS DEPAR'MN't
Date
TOWN HALL
m't on File IW SULLIVAN VENUE
✓Date of Expiration SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of'a applicant S}. 'rlr,�j, .Y r
PP 1 c Phone No.
Location of proposed work .
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Describe fully nature of permit requested. r
Insurance on file with Town yes no Date policy expires
Name of Insurer
oApproximate time for completion 2 , �`�� Desired starting ate
u Call before you dig ticket No.
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aShow sketch of proposed work or furnish 2 copies of separate drawings l
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QApplicant 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 re air
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 f 1
APPROVED: DATE APPROVED: DATE ' >�
Supt, of Highways F,��D Town Engineer .
YOR INSPECTOR: Date work started
Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encounte-red.
Material slips attached: yes no Dated for Permanent repair
Signed.
_spector