HomeMy WebLinkAboutWater Street Cut Permits Nevers Road (2) TOWN OF SOUTH WINDSOR N o 7 3 6
BOND _ _
Am't Req. PUBLIC WORKS DEPARIVENT Date
TOWN HALL
Am't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLIC TI F ERMIT
FEE
Name and address of applicant STjq Trc x Phone No.
Location of proposed work
Describe fully nature of permit requested'
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Insurance on file witri Town yes no Date policy expires
Name of Insurer
oApproximate time for completion Desired starting date
Call before you dig ticket Pdo.
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.� Show sketch of proposed work or furnish 2 copies of separate draNvir gs
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Applicant is responsible for contacting the Police Department and CALL BEFOYOU 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,- " 1, t
APPROVED: DATE APPROVE
Supt. of Highways To n E eer
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
Signed
Inspector