HomeMy WebLinkAboutWater Street Cut Permits 196 Newberry Ro BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on File-,;, 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION, FOR PERMIT
FEE $10.00
Name and address of applicant "�7•hH(l ,.f Phone No
Location of proposed work 11N, +•� J,,�r
Describe fully nature of permit requested }�11� ;r v 117
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Insurance on file with Town _
Name :of Insurer yeT. no Rate policy expires
o Approximate time for completion )esirel starting date
u Call before you dig ticket 110. g �_1Ty gl//
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aShow' sketch of proposed work or furnish 2 copies of separate drawings
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10
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A' ltcat5t wrespopsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree.ryto.,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 1n, 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.)
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Signed
APPROVED: DATE APPROVED; DATE "
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started mate completed p ed
Sufficient notification received: yes no T.ylee •f repair: Perm, Temp,
Unusuatl•_conditonr .encountered�.,4_
Material slips 'attached: yes ., no , Dated for Permanent repair
Signed
Inspector