HomeMy WebLinkAboutRepair gas pipe Street Cut Permits 45 Ju BOND ��9
TOWN OF SOUTH WINDSOR
Am't Req._ PUBLIC WORKS DEPARTMENT ate D
Am TOWN HALL
APPLICATION FOR PERMIT
on File 1540 SULLIVAN AVENUE
ate of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
Permit Expires
FEE $10.00
Name and address of applicant `. I r�f .
1 • . Phone No. '(S Z _; "�C�-
Location of proposed work �: U
Describe fully nature of permit requested .. ',_
Insurance on file with Town '-Yes-) no Date policy expires
Name of Insurer
o Approximate time for com letiin tT>
p Desired starting date
Show sketch of proposed work or furnish 2 copies of separate drawings
s
g
a
o raj
s~
O .4
,,
04
a�
a�
a
0
Q
O
4..,
O
U
Applicant 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 1� . �,� •d.�
APPROVED. DATE APPROV D: DATE` ,
Supt. of Highways �G . 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 for Permanent repair
Signed
Inspector