HomeMy WebLinkAboutInstall motor vault Street Cut Permits S BOND TOWN OF SOUTH WINDSOR
AIIt Req. - PUBLIC WORKS DEPA"MENT Date
TOWN HALL
mitt on File 1540 SULLIVAN_AVENUE Permit No. y
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires_
APPLICATION FOR PERMIT
/ FEE
Name and address ofapplicant,. . Phone No. c j, `
Location of propose wor
44-44
Describe fully nature of permit requested:
Insurance on file with Town yes no Date policy expires
Name of Insurer `��-
oApproximate time for completion Desired starting date - -
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4d Call before you dig ticket tdo.
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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, rulob and
regulati6ns. for permits as outlined in the Town of South Windsor's (Pavement Cut Re"'hti®ns.)
�t;t a t.: `,►J /� +� ��Signed
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APPROVED: DATE APPFLOVED: DA'TE/O-.�,i
Supt. of Highways o n nee
FOR iNSPECTOR: Date work started
Date comtpleted,
ufAi Ont noti_iration`rec-eiv-ed '_:_.fires no. ype of repair: Perm, Tempt
Unusuafi conditions encountered-'
Material slips attached`: ye's no Dated for Permanent repair -
Signed
Inspector