HomeMy WebLinkAboutInstall new d/w Street Cut Permits 546 K solvD TOWN OF SOUTH WINDSOR N° 731
Am It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
nn't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLIC TION F P RMIT Permit Expires
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Name and address of applicant
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Location of proposed work - 6 �Nrr 57-
Describe fully nature of permit requested. ;JA
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Insurance on file with Town es no Date policy expires
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o Approximate time or completion Desired starting ate
u Call before you dig ticket Pdo.
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sketch of proposed work or furnish 2 copies of separate drawin`
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QApplicant 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: ` ��
Supt. of Highways -=-- -`•, �.��DATE �7 /�
Town Engineer 'T—/-�"'�
FOR INSPECTOR: Date work `started
Date completed
Sufficient notification received: yes no Type of repair: Perrin. Teii
-Unusual conditions encountered P•
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector