HomeMy WebLinkAboutCurb Cuts Street Cut Permits 769 John Fi BO—NA TOWN OF SOUTH WINDSOR 352
Am It Req. ,�f PUBLIC WORKS DEPARTMENT
Am't on File TOWN HALL Date
1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
ate of Expiration
APPLICATION FOR PERMIT Permit Expires ,,._1.. 3
" FEE $10.00
Name and address of applicant
NIJfi'j_kJ I �1 [L, Phone No.
Location of proposed work �f
Describe fully nature of permit requested
Insurance on file with Town
i no Date policy expires _ ��•-
Name of Insurer
o Approximate time for comp etion ... r
.r- esired starting date
Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant is responsible pp ponsible for contacting the Police Department and CALL BEFORE YOU DIG. C, J.
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.)
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Signed
' 7 / "
APPROVED: DATE
APPROVED ATE -7
Supt. of Highways Town Engineer
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- -Datecf'for Permanent repair
Signed
Inspector