HomeMy WebLinkAboutSanitary Sewer Street Cut Permits Lot 34 BOND TOWN OF SOUTH WINDSOR - 0 72
Arn't Req. PUBLIC WORKS DEPARTMENT
rDate
m't on File 1540 SULLI AN VENUE
ate of Expiration
SOUTH WINDSOR, CT 06074 Permit No. ---__
APPLICATION FOR PERMIT Permit Expires
FEE - i D.
Name and address ofapplicant ti
s ? Phone
Location of proposed work
Describe fully nature of permit requested. -
Insurance on file with Town 'yes,'; no Date policy expires
Name of Insurer
o Approximate time for completion ; ti/�
Call before you dig ticket P1o_ �. Desired starting date
aShow sketch of proposed work or furnish 2 copies of separate d
(d P rawings
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QApplicant is responsible for artm contacting--the Pglice-Dep ,�
I agree to furnish to the Town of South Windsor the amount of
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reimburse the Town of South Windsor for any expenses incurred by thee Town for ma ntennance orand
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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:i,. %
f DATE
Supt. of Highways
;I"own itgineer
r i
FOR INSPECTOR: Date work started
Suff noti ication received: yes no T Date completed
Unusual conditions encountered ype of repair: Perm.—Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector