HomeMy WebLinkAboutDriveway Street Cut Permits Lot 5 Kent L TOWN OF SOUTH WINDSOR N° 857
BOND - -
Ain't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
m't on File 1W SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT(K074
Date of Expiration Permit Expires
APPLICATION FOR ERMIT
FEE ��
Name and address of applicant Phone No.
Loc
ation of ro osed work—
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Describe fully nature of permit requested.
Insurance on file with Town yes, no Date policy expires
Name of Insurer
Approximate time for completion j ? Desired starting date J j
Call before you dig ticket N
U
Show sketch of proposed work r furnish 2 copies of separate drawings
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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: DATE
-`
Supt. of Highways 7 .�' Town E gi eer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: .Perin.- Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector