HomeMy WebLinkAboutDriveway Street Cut Permits Lot 9 Jonath BOND TOWN OF SOUTH WINDSOR N2 _ _ 625
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q• PUBLIC WORKS DEPARTMENT Date
It on File TOWN HALL
1540 SULLIVAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
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Name and addre s s of applicant
Phone No.
Location of proposed work L �-
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Describe fully nature of permit requested
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Insurance on file with Town
Name of Insurery-e--s� n° Date policy expires
o Approximate time for completion Desired starting date
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Call before
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You digicket P10.
ags Show sketch of proposed work or furnish 2 copies of separate drawin
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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: 7
Supt. of Hig s
hway DATE 3-3� =ice
7, Town Engineer
. FOR INSPECTOR: Date work started
Sufficient notification received: no � Date completed
es
Unusual conditions encountered Y Type of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector