HomeMy WebLinkAboutDriveway Street Cut Permits Lot 4 Jonath BOND TOWN OF SOUTH WINDSOR t ft()
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION� jl I�NjI►� permit Expires
FEE (-
Name and address of applicant <
j 1 j Phone No.
Location of proposed work a
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Describe fully nature of permit requested.
Insurance on file with Town yes no Date polic
s~ Name of Insurer y expires
O Approximate time for completion
Call before you dig ticket 140. Desired starting date ,
aShow sketch of proposed work or furnish 2 copies of separate d(d P ravings
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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 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: l
Supt. of Highways DATE 4
�� Town Engineer
FOR INSPECTOR: Date work started
Sufficient notification received: Date completed
Unusual conditions encountered St no Type of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector