HomeMy WebLinkAboutSewer Installation Street Cut Permits 70 i
BOND TOWN OF SOUTH WINDSOR x•`A
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Am't Req. c;:,< /t, PUBLIC WORKS DEPARTMENT Date
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rn't on File �'���'1 6 TOWN HALL 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant D Ce- Phone No. <JS
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Location of proposed work -2 0 1 4 �,- 4t
Describe fully nature of permit requested / .5 f 11
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion �,/ — 3 3_ 7 Desired starting date yr /�
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u Show sketch of proposed work or furnish 2 copies of separate drawings
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04
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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 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: '✓` r / ATE Z
I
Supt. of Highways Town Engineer
FOR INSPECTOR: Date, work starte
d 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