HomeMy WebLinkAboutSewer Hookup Street Cut Permits 1265 Joh Un
04
SOWN OF SOUTIR WINDSOR '
Arx�'t Req. (1 . PUBLIC.WORKS;DEPARTMENT
Date
t on File
TOWN HALL
1540 SULLIVAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
FEE $16.00
Name and address of applicant .r(,u �-#tnyv1
S�„�Z, �f Phone No. Y-.'7
Location of proposed work
Describe fully nature of permit requested
s
Insurance on file with Town es no
Date policy expires
Name of Insurer
Approximate timeT,f}r oomplEton _Desired starting date
Call before you dig' cket Edo.
Show sketch of proposed work or .furnish 2 copies of separate drawin
gs
v ,
0
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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
worts. in connection with this pgrritt 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:
Supt. of Highways DATEr
Town Engineer
FOR INSPECTOR: Date work started
Date completed
Sufficient notification receivedc yes no Type ,of repair: Per Unusual conditions encountered memP..
.Material s-l-rps attacked: yes- `no at—
, . -
_ Signed -
Ino0ector