HomeMy WebLinkAboutRoad Cut Permit Street Cut Permits Never BOND TOWN OF SOUTH WINDSOR Na $8
;AmIt Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH_ WINDSOR, Cr 06074
Date of Expiration Permit Expires
APPLICATION,�OR;PERMIT
FEE
Name and address of applicantSa ;' Phone-No.
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town ye no Date policy expires
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Name of Insurer ��: .
oApproximate time for completion_� _ r` - 17-, Desired starting date - ..
Call before you dig ticket 11o. % ;
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aShow sketch of proposed work or furnish 2'copies of separate drawings
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4 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.)
Signer'` , c r_
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AP1ROVED. DATE APPROVED:
- DATE `�
Supt. of Highways pt,�� Town Engineer
FOR INSPECTOR: Date work started Date o c mpleted
Sufficient notification received:. .`yes_ no Type of repair; Perm. Temp.
Unusual conditions encountered
Material slips attacbed: yes no Dated for Permanent repair
Signed -
Inspector