HomeMy WebLinkAboutWater Street Cut Permits 313 Pleasant Va M 1' 0 371
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
IWMAM't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATIO FOR PERMIT
FEE $10.00
1 �n �
Name and address of applicant Phone No.
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Loc tion of propose wor
D e s c r 1-b a fulIy nature-of ermit requested
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Insurance on file with Town e f no Date policy expires
Name of Insurer K 7 � OL CRN ( !
o Approximate timer completion Desired starting date
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Show sketch of proposed work or furnish 2 copies of separate drawings
04
04
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0
0
0
04
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4.
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O" Applicant is responsible forcontacting the Police Department and CALL BEFORE YOU DIG. A'2 1 `r
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'y(pavJmTet.� Regulations.)
Signed
APPROVED: DATE APPROVED: DATE f,-
Supt. of Highways 7 c 2:2 Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient" notification received: yes no .Type of repair: Perm. Temp.
P
- - Unusual conditions encountered _ -
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector