HomeMy WebLinkAboutGas Service Street Cut Permits 53 Overlo BOND
TOWN OF SOUTH WINDSOR No 716
Ain't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
Am't on Fil ,> 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR,CT 06074
Date of Expiration Permit Expires
APPLICATIO OR PERMIT
FEE
Name and address ofapplicant y txs w=- > Phone No.�-Z7' {373
Location of proposed work CW62C4 001< Q
Describe fully nature of permit requested:
Insurance on file with Town yes�� no Date policy expires /
Name of Insurer t /.1
o Approximate time for completion / Desired starting date /
Call before you dig ticket No. _V:q-t, 7
a Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicanr�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 roles and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.
Signed ,
APPROVED: DATE APPROVED: I: DATE
Supt. of Highways p� Town Engineer
FQR `SPECTOR: Date work started Date completed
of icient notification received: yes _ no ype of repair: Perm. Temp,.
Unusual, conditions encountered
Material slips attached: yes no Dated for Permanent. repair
Signed
i s�iector