HomeMy WebLinkAboutStorm sewer Street Cut Permits 150 Never BOND TOWN OF SOUTH WINDSOR '
A 't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
'ton File 1540'SULLIVAN AVENUE Permit'No.
r SOUTH WINDSOR, CT 06074
ate of Expiration r' Permit Expires
APPLICATION FOR PERMIT
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Name and address of'applicant Cc3AS1'hLv ,,,, Phone No.
LogAtion of proposed work
escribe fully nature of permit requested.
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Insurance on file with Town Qes no Date policy expires
Name of Insurer
o Approximate time for completion DAY Desired starting date
u Call before you dig ticket No.
Show sketch of proposed work or furnish copies of separate drawings
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QApplicant 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 regpired 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 Regulatians.)
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APPROVED: DATE APPROVED: ,/� DATE /
Supt. of Highways 1/2
t� Torun Engineer X
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Fft. INSPECTOR: Date work started Date completed
Su`£fit;ient n-otification received: yes no T e f repair: PeryP. o
�Tnusual conditions encountered 1
Material -slips attached: yes no Dated fdr Perrhanent repair
\ Signed :4
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