HomeMy WebLinkAboutUtilities and telephone Street Cut Permi z- ....
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BOND
TOWN 'OF SOUTH WINDSOR
Ai7'It Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
it on File' 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT'06074
ate'of Expiration. T_ Permit Expires
APPLICATION. F R PERMIT
-FEE $10.00
Na a and a resy,of applicant �.�-�1e C o.�. s: Phone No. G '53 -• �J", a ,
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Locat, of proposed worlF
/e*zf,S. - r
escribe fully nature of permit requested dh llEs 5�;.ii 5
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{ Insurance on file __m&ith Town e no Date policy expires C 3i, /59n
Name of Insurer �
}} Approximate time:<for completion Desired starting date
1 Call before you dig' 'Cr, etrlk
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' Show sketch of proposed work or furnish 2 copies of separate drawings44
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Applicant is responsible for contacting th Police Department nd 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 �a1
Supt.-of] ighways y��P Town Engineer
FOR INSPECTOR: - Date work started Date com leted
P
fTT
u ficient-,notification received: yes no ype of repair: Perm. Temp.
C(jr1Uft%.LU11V encountered
attach:ed: ._yes___ no: _ Dated-for P-errbinent--r-epair--
: Signed
.. Inspector