HomeMy WebLinkAboutDriveway Street Cut Permits BOND TOWN OF SOUTH WINDSOR ED - -
826
1V�Mn't
Req. PUBLIC WORKS DEPARTh NT Date
TOWN HALL
on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICITION FRR PERMIT
FEE IC? � K 2c`Ca
Name and address of applicant Phone No. ) '
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town yes no Date policy expires
Name of Insurer `
oApproximate time for completion) Desired starting ate
Call before you dig ticket No.
U
a Show sketch of proposed work or furnish 2 copies of separate drawings
w
O
O
O
04
x
y
O
a
c°�
o
u
a
4 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:
DATE
Supt. of Highwaysp,4p Town Engineer -
FOR INSPECTOR: Date work started 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