HomeMy WebLinkAboutDriveway Street Cut Permits Lot 26 Rimfi BOND TOWN OF SOUTH WINDSOR N- _ _ 861
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPE ICATI?y FOB PER T Permit Expires
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Name and address of applicant (D A 10 Phone No.
Location of proposed work Lot 26 Rimfie Drive
Describe fully nature of permit requested
Insurance on file with Town �ye;:,, ; no Date policy expires
Name of Insurer Pt-
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o Approximate time for completion V j _ 9y Desired starting date
u Call before you dig ticket 14o.
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Show sketch of proposed work or furnish 2 copies of separate drawi
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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 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.)
Signet 4 -
APPROVED. DATE r ? �}
Supt. of Highways APPRVED: DATE
lw0 Town Engineer
FOR INSPECTOR: Date work started
es
Sufficient not( (cation reeved: Date completed _
Unusual conditions encou9tered y no Type of repair: Perm. Temp.
--------Material slips attached:-yes no D ed for Permanent repair
Signed
Inspector