HomeMy WebLinkAboutDriveway Street Cut Permits Lot 11 Pheas TOWN OF SOUTH WINDSOR � S8
BOND '
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SUI,LIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of applicant �pj � -{, Phone No. Zv
_ Location o pro posed work v
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Describe fully nature of permit requested. 4e, b+e
Insurance on file with Town no Date policy expires
c Name of Insurer y} ,off lf>Ir '
o Approximate time for completion f Ljt4!�z Desired starting,date /per-/
Call before you dig ticket Pdo. J
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a 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
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APPROVED. DATE APPROVED:
-: ✓� - DATE
Supt. of Highways 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