HomeMy WebLinkAboutStreet Cut Permits Lot 5 Jonathan Lane BOND_ TOWN OF SOUTH WINDSOR O - 828
Am't Req. PUBLIC WORKS DEPARTMENT '
TOWN HALL Da
TION FOR PERM te G -
Am't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No. S
APPLICAIT Permit Expires iy;ll
FEE
Name and address of applicant
Phone No.
Location of proposed work
Describe fully nature of permit requested.
/ 1
Insurance on file with Town yes) no Date policy expires
Name of Insurer ~'
oApproximate time for completion
p Desired starting date
u Call before you dig ticket No.
g
a Show sketch of proposed work or furnish 2 copies of separate drawin s
rd
o
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14
a)
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a
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QApplicant is responsible for contacting the Police Department and 6 :I,BEFORE U 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 I`
APPROVED: DATE c
APPROVED, it-_ �_
Supt, of Highways DATE /`1 `_
mown ineer
>� FOR INSPECTOR: Date work started D
Sufficient notifi es no Tcation received: ate completed
Unusual conditions encountered Y Type of repair: Perm. Temp.
Material .slips attached: yes no Dated for Perrrianent repair
Signed
Inspector