HomeMy WebLinkAboutRepair walks Street Cut Permits Rainbow BOND TOWN OF SOUTH WINDS OR No 8-07
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 00074
Date of Expiration Permit Expires
APPLICATION ICATIO�b YOR PERMIT
Name and address of applicant T Phone No.
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Location of proposed work l^
Describe fully nature of permit requested.
Insurance on file with Town Date policy expires_s--Z,-�
Name of Insurer
oApproximate time for completion / Desired starting date �?
Call before you dig ticket 14o.
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Show sketch of proposed work or furnish 2 copies of separate drawings
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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• DATE � b L�
Supt. of Highways r i o n E neer
WF FOR INSPECTOR: Date work started Date completed
Sufficient_notification.received: yes no Type of repair:- Perm. Temp. -
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signedgt.,.,.
Ins a or
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