HomeMy WebLinkAboutWater Street Cut Permits 986 Pleasant Va TOWN OF SOUTH WINDSOR O 822
BOND - -
Am't Req._ PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR,CT 06074
Date of Expiration Permit Expires
APPLICATIO ,F PERMIT
FEEh� 2
Name and address of applicant ����o c r Phone No. V
Location of p oposed work
Describe fully nature of permit requested.
Insurance on file with Town e no Date policy expires
Name of Insurer
oApproximate time for completion Oa s Desired starting date
u Call before you dig ticket 110. 9 01 13 O g 3
aShow sketch of proposed work or furnish 2 copies of separate drawings
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Q" Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
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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 ma'ntpnance or repair
work in connection with this permit and that I am familiar with and wi abi ;b' `the rules and
regulations for permits as outlined in the Town of South Windsor's (Paved t G t; galations.)
SignedIL
APPROVED. DATE APPROVEfD?+ - 7., DATE'/�l /`
Supt. of Highways 'Town nj neer
i
FOR INSPECTOR: Date work started Date completed
Sufficient- notification received:_ yes no Type .of .repair:-Perm. T-emp.
Unusual conditions encountered
Material slips attached: yes no Dated for P'erman8nt repair
' Signed
Inspector