HomeMy WebLinkAboutStorm and sanitary sewer Street Cut Perm 0 5��
BOND TOWN OF SOUTH WINDSOR
Am It Req. PUBLIC WORKS DEPARTMENT Date
Am't on File TOWN HALL1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration
APPLICATIO FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant Z12V '('wS; ��. "/VC phone No. ?y q FAO 7
Location of proposed work �'1 C /� �'�U � e C7 /r1
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Describe fully nature of permit requested dye S�wt
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion w�F kf Desired starting date �?rt
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Show sketch of proposed work or furnish 2 copies of separate drawings
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PApplicant 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 Re ions.)
Signed .;
APPROVED: DATE APPROVEb: _--4)7- :' DATE;
Supt. of Highways " Town Engineer /
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Tem
Unusual conditions encountered - p'
------- Material slips attached: -"
P � yes no Dated for Permanent repair
Signed
Inspector