HomeMy WebLinkAboutWater Street Cut Permits Nevers Road (3) 35
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date F'
TOWN HALL
Ain't on File 1540 SULLIVAN AVENUE Permit No. 7 ^
SOUTH WINDSOR, CT 06074
4Date of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicar_ � � �a t!.° � ,i :; r► 'hone No.2`
Location of proposed work N vers Rd . _ Entr°anct� of h1'.;1h sCI-100
cirivei;ay.;
Describe fully nature of permit requested. Excavate: road to instiall. Wu 7c.7
t< �} for -choul cater sy totn
Insurance on file with Town yes no Date policy expires et . 1j , i �<
c Name of Insurer T*.c Hart.f crd
o Approximate time for completion Desired starting ate 2 i9/91
Call before you dig ticket 11o. 91070285,
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a Show sketch of proposed work or furnish 2 copies of separate drawings
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0 See lttacher sketr.h, area e�r_i.(7s�r in f.,ink.
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QApplicant is responsible for contacting the Police Department and GALL 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
t
APPROVED. DATE APPROVED: DATE
Supt. of Highways y.j Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: ,_ye-$_ no 'hype of repair: Perm. Temp. --
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed.
Inspector