HomeMy WebLinkAboutSewer and drain Street Cut Permits 110 R O
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE - Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE !
Name and address of applicant ,F, /r , e Phone No.
Location of proposed work
Describe fully nature of permit requested. L-
Insurance on file with Town yes no Date policy expires ;
Name of Insurer
oApproximate..time. for completion Desired starting date
Call before you dig ticket 110 '
v
----Sh�oaw—skate h--o�roposed work or furnish 2 copies of separate a drawings
04
Cd
w
0
c
0
�\
s+
_ o. t `
v ;
W
04
o v'
a i
U "
a '
Q Applicant is responsible for contacting the Police Departure t and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor die-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.)
Signed
APPROVED: DATE APPROVED: DATE
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient noti_ication received: yes no 'Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector