HomeMy WebLinkAboutDriveway Street Cut Permits Lot 30 Kello BOND TOWN OF SOUTH WINDSOR - egg
It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
't on File 1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR, CT 66074 Permit No.
APPLICATION FOR PERMIT Permit Expires
Name and address of applicant J �j
Phone No.
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town
Name of Insurer nO Date policy expires
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0 Approximate time for completion
Call before you dig ticket No. �' Desired starting date
Show
a sketch of proposed work or furnish 2 copies of
a separate drawings r
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,04 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 reimburse the Town of South Windsor .for an expenses p° � required and to
work in connection with this y lenses incurred by the Town for maintenance or repair
regulations for nernut and that I am familiar with and will abide by 'the rules and
permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed ,
z �
APPROVED: DATE
Supt, of Highways `PROVED }' DATE / i
Town.' gineer —�--_—
FOR INSPECTO
R: Date work started
Sufficient notification received: yes no T Date completed
Unusual conditions encountered ype of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair `
Signed
Inspector