HomeMy WebLinkAboutGas Main Street Cut Permits 169 Kelly Ro BOND TOWN OF SOUTH WINDSOR 612
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Ain't Req. PUBLIC WORKS DEPARTMENT
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TOWN HALL 3
't. on File 1540 SULLIVAN AVENUE i'
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATION OR PERMIT Permit Expires
FEE �'..`
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Name and address of applicant �ifbJ KI- - ,Q,;, Phone No.
Location of proposed work f., 1KELL
Describe fully nature of permit requested. .,��� ;
insurance on file with Town yes no Date policy expires - , --
Name of Insurer , ref --.._ - /
o Approximate time for completion 'A Desired starting date �...�
Call before you dig ticket 14o. 9-
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0. Show sketch of proposed work or furnish 2 copies of separate04 drawings
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.� E 'e f
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: DATE
Supt. of Highways j vn E, 2ne rr
g< 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