HomeMy WebLinkAboutDriveway Street Cut Permits 24 Parkview ell 6
BOND TOWN OF SOUTH WINDSOR
Am It Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
m It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of applicant 17):,..,1�:,� Phone No.
Location of proposed work
Describe fully nature of permit requested.
Insurance on file with Town yes_ ngJ Date policy expires
0 Name of Insurer w -"—"-
o Approximate time or completion { �. �,� Desired starting date �; y
Call before you dig ticket i1o.
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Show sketch of proposed work or furnish 2 copies of separate drawings
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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 6 h«,
APPROVED: DATE APPROVED: , - DATE
Supt. of Highways Tle� Town Engineer
FOR INSPECTOR: Date work started Date completed
Su_fficent notfi�aton_receved: yes_ no_ Type_of repair:- Perm.- ---'I"emp.------
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector