HomeMy WebLinkAboutSanitary drain Street Cut Permits Lot 41 BOND TOWN OF SOUTH WIND _ 877
m A 't Req. SOR
PUBLIC WORKS DEPAIt
't on File
TOWN HALL Date
1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR, CT o6074 Permit No.
APPLICATIO Permit Expires
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FEE I T
Name and address of applicant
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Location
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of proposed work
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Describe fully nature of p q Q` Ua
permit re uested.
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Insurance on file with Town y no
Name of Insurer es_ Date policy expires
° Approximate time for completion
u Call before —
you dig ticket PJo. �'�' Desired starting date
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Q04 4 Show sketch of proposed work or furnish 2
copies of separate drawings
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Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. a.+
I agree to furnish to the Town of South reimburse the Town of South Windsor for any W eg sor the amount of bond or de
work in connection with this expenses incu Y Posit required and to
Permit and that I am f rred b the Town for maintenance or repair
regulations for permits as outlined in the Town I amiliar with and will abide b t
he South Windsor's (Pavement Cut Regulations.)n� and
Signed
APPROVED.
DATE
Supt. of Highways ---APPROVED:
DATE U'//' a✓
Town Engineer _-------
FOR INSPECTOR: Date work started
Sufficient notification received: Date completed
Unusual conditions encountered_ yes nO --Type of repair: Perm.
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Material slips attached: es Temp.
y no Dated for Permanent repair
Signed
Spector