HomeMy WebLinkAboutDriveway Street Cut Permits 177 Kent Lan so ND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT
m TOWN HALL Date
A 't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant.(
Phone No.
Location of p oposed work t 4 Describe fully nature of permit requested.
Insurance on file with Town C-_yes,; no Date policy expires
c Name of Insurer _
oApproximate time for completion Desired starting date i f
u Call before you dig ticket rio.
aShow sketch of proposed work or furnish04 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 , -v
APPROVED:
DATE APPROVED:' 3- DATE J'jL /
Supt. of Highways To ' neer
• i
FOR INSPECTOR: Date work started
Sufficient notification received: es no T Date completed
- Unusual conditions encountered Y ype of repair: Perm. Temp.
--------Material slips attazhe"d: yes no - -Dated for Permanent repair
Signed
Inspector