HomeMy WebLinkAboutDriveway Street Cut Permits 155 Kent Lan BOND
TOWN OF SOUTH WINDSOR
Am It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL FDate
't on File 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 o.
Date of Expiration
APPLICATION FORPERMIT Permit Expires
FEE
Name and address of applicant
- Phone No.
Location of pro osed work r ,
Describe fully nature of permit requested
Insurance on fie with Town `yes no Date
Name of Insurer policy expires
c
o Approximate time for completion . Desired starting ate . - ( ._
d Call before you dig ticket 140.
u
aShow sketch of proposed work or furnish 2 copies of separate drave►in s —_
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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 de
reimburse the Town of South Windsor for an ex posit required and to
y parses 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
lations.
Signed
APPROVED. DATE APPR VED: 71L '- DATE
Supt. of Highways
T. n En veer
• FOR INSPECTOR: Date work started
Date completed
Sufficient notification received: yes no Type of repair: Perri._- *
- e�—Unusual conditions encountered
Material slips -attached:yes-- no Dated for Permanent repair
Signed
Inspector