HomeMy WebLinkAboutInstall 24 rep to CB Street Cut Permits BOND TOWN OF SOUTH WINDSOR
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Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Arn!t on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
-Date of Expiration Permit Expires
APPLICATION a OR PERMIT
FEE
Name and address of applicant—,.' # !!= 1 1 Tv i S Phone N t
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Location of proposed work -
" cribe fulll.Ynature of permit requested. _w S f) I
Insurance on file with Town yes no Date policy expires
Name of Insurer
oApproximate time for completion )a g Desired starting ate
Call before you dig ticket Flo. T
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a Show sketch of proposed work or furnish 2 copies of separate.drawing's
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. �dISG��D
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
ywork 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
11 It
APPROVED. DATE APPROVED: . DATE
Supt. of Highways o*n •EkotAeer
f-.PR INSPECTOR: . Date work started J Date completed
f icient notification received: yes no ype of repair: Pexm.. T_exnp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
in$pector