HomeMy WebLinkAboutRepair blow off Street Cut Permits Saddl NWO
BOND TOWN OF SOUTH WINDSOR 840
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 E
APPLICATION FOR PERMIT Expires
FEE
Name and address of a licant r
PP L l� L'U�� tF i i � Phone No /i 2 3
Location of proposed work Z7 ( .
Describe fully nature of permit requested VG
Insurance on file with Town re no Date policy expires
Name of Insurer
0 Approximate time for completion Desired starting date
a Call before you dig ticket 14o.
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a. Show sketch of proposed work or furnish 2 copies of separate 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 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 4,1-I_ .rf ( fl�J�t .�
APPROVED: DATE APPROVED: /; ' - DATE -
Supt. of Highways 7`4 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