HomeMy WebLinkAboutSewer Lateral Street Cut Permits Lot 6 J BOND TOWN OF SOUTH WIDSOR N 2 - - 829
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Am It Req. PUBLIC WORKS DEPARjMENT
Date. -� - �7 �-.
TOWN HALL
It on File 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLIC TI03 T FOR E IT Permit Expires
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Name and address of applicant �� � Phone No. E7
4 � 7
Location of proposed work (t
Describe fully nature of permit requested.
Insurance on file with Town yew' no Date policy expires -,Z
Name of Insurer — E
o Approximate time for completion Desired starting date �� I
u Call before you dig ticket No. ,d
a Show sketch of proposed work or furnish 2 copies of separate drawings
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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:
Su t. of Highways DATES c-
PTown 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- Vated`ior PerManent repair
-Signed
IAP sector