HomeMy WebLinkAboutDriveway Street Cut Permits Lot 40 Rimfi BOND TOWN OF SOUTH WINDSORQ - 97
Am't Req. PUBLIC WORKS DEPARTMENT
't on File - TOWN HALL Date
1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR CT Permit No.
06074
APPLICALTION FOR PERMIT Permit Expires
FEE ��`
Name and address of applicant
Phone No "- C
Location of op Bed work `y
Describe fully nature of permit requested C
Insurance on file. with Town � V
c
Name of Insurer yes no Date policy expires
..q Approximate time for completion / Sys, Desired startin date
u Call before you dig ticket 11o. g ir> r A
a
Show sketch of proposed work or furnish 2 copies of separate
cd
drawings
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QApplicant 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
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance
work in connection with .this Posit required and to
permit and that I am familiar with and will yhe or repair
regulations for permits as outlined in the Town of South Windsor's (Pavement Cute Regulations.)
and
Signed
APPROVED: DATE
Supt. of Highways APPROVED ,'; ' ,.a' - DATE
Town Engineer
FOR INSPECTOR: Date work started
Sufficient noti ication received: Date completed
Unusual conditions encountered. yes no 'Type of repair: Perm. T
-- -- - Material slips attached: yes no Dated for Permanent repair emp.
Signed
Inspector