HomeMy WebLinkAboutDriveway Street Cut Permits 546 King Str BOND TOWN OF SOUTH WINDSOR N° _ 720
Am tt Req. PUBLIC WORKS DEPARTMENT
Am It on File TOWN HALL F
ate
1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
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Name and address of applicant j
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L PX 11 r Phone No. �� .�?/o L
Location of proposed work
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Describe fully nature of permit requested.
Insurance on file with Town yes no Date
c Name of Insurer ires
.° Approximate time for completion
u Call before you di Desired startin date
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Show sketch of proposed work or furnis 2 co 'es of separa a dr
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QApplicant is responsible for contacting the Police artment and CALL BEFORE YOU DIG.
I agree to furnish to the Town o South Windsor the amount of bond or de
reimburse the Town of South Wi sor for an expenses posit required and to
work in connection with this y penes incurred by the Town for maintenance or repair
regulations for rmit and that I am familiar with and will abide by the rules and
permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed
APPROVED DATE
Supt, of Highways `PROVED: DATE
Town Engineer
FOR INSPECTOR: Date work started
Sufficient noti ication received: yes no T Date completed
Unusual conditions encountered ype of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector