HomeMy WebLinkAboutWater Street Cut Permits Kelly Road BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
't on File 1540 SULLIVAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant 6—17 W/1 r�l� C,� Phone No.
Location of proposed work V1
Describe fully nature of permit requeste(. .-'
Insurance on file with Town— . yes no Date policy expires
Name of Insurer ')/+i / /l
o Approximate time for completion / 5 Desired starting date
u Call before you dig ticket No. % /
4 Show sketch of proposed work or furnish 2 copies of separate drawings
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Q 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
APPROVED: DATE APPROVED:(� � y✓� DATE
Supt. of Highways —
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 Dated for Permanent repair
Signed
Inspector