HomeMy WebLinkAboutDriveway Street Cut Permits Lot 6 Jonath BOND TOWN OF SOUTH WINDSOR N cP
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
m't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION XOR PERMIT Permit Expires
FEE 0
Name and address of applicant i+
Phone
Location of proposed work
i
Describe fully nature of permit requested.
Insurance on file with Town no Date policy expires
Name of Insurer -.
o Approximate time for completion
Desired starting date
u Call before you dig ticket 140. _
aShow 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 wi11 abide by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Reguaatiansl
Signed '
APPROVED: DATE APPROVED: --`� �. "
Supt. of Highways 7 DATES
Town Engineer
FOR INSPECTOR: Date work started
Sufficient notification received: es Date completed
Unusual conditions encountered y no Type of repair: Perm. Temp.
Material slips attached: yes no Dated-tor Permanent repair
Signed
Inspector