HomeMy WebLinkAboutDriveway Street Cut Permits Lot 29 Quail BOND l� OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN Date
m't on File 1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR, CT 06074 PermiiE No.
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of ap licant
Phone
No Z
Location of propose work
Describe fully nature of permit requested. 1
Insurance on file with own
c Name of Insurer , es no Date policy expires
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.� Approximate tim for compl tion -
Call before ou di T Desir,ed starting
Y g ticket 140. g ate
aShow sketch of proposed work or furnish 2 copies of se parate drawings
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Applicant 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 de sit
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance Ao required and to
work in connection with this permit and that I am f Hance or repair
regulations for permits as outlined in the Town of South Windsorts (Pavemand ent Cute by Regulations.)the rules and
Signed
APPROVED: DATE APPROVED:
Supt. of Highways ' DATE/
Town Engineer
FOR INSPECTOR: Date work started
Sufficient tification received: yes no T Date completed
no
Unusual conditions encountered ype of repair: Perm. Temp.
Material slips attached: yes no Datwd for Permanent. repair-
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- Signed.
spector