HomeMy WebLinkAboutGas Street Cut Permits 617 Nevers Road BOND TOWN OF SOUTH WINDSOR 399
Am It Req. PUBLIC WORKS DEPARTMENT Date
j Am't on File TOWN HALL! 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00 ?�JTI
Name and address of applicant PhoneNo.42' ` ' /
Location of proposed work --+ -
Describe fully nature of permit requested _-� -�„ye e, �r^' t ,,
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion fly _Desired starting date
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Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant 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 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 �
APPROVED: DATE APPROVED: ,
ATE_ /Z-7-pft��
Supt. of Highways Town Engineer j
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
— ---- aterial slips attached: yes no Dated for Permanent repair
Signed
Inspector