HomeMy WebLinkAboutWater Street Cut Permits Sea Pave Road/B r BONIXTOWN QF
SOUTH WINDSOR
't R q. PUBLIC wOPXS DEPARTMENT
't on File "OWN HALL Date
.1540 SULLIVAN.AVENUIE
,Ate of Expiration SOUTH WIIVDSCdR, CT 06074 Permit No.
t {,. APPLICATION I"OR PERMIT Permit Expires
FEE"$10,00
Name and address of:applicant �(
tc. Phone No.
Location of rod
P , pgsed work (Iortyq
o v r Wv/h W% #
F De'scribe f 1, y nature of 1 rnit re ueste -
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Insurance on file with Town
Name of Insurer es nO Date policy expires
r`x Approximate tirnefoxompltio,::
a. Call before you c7j Desired stung date:gticket rdo. t
1. ,g
Show sketch of proposed work or'furnis] Z copies of se ara
} s p to drawings "
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��' Applicant s responsi le for:contacting the Police Departtent and CALI,BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the a�inonn of bond or
deposit r
reimburse the Town of South Windsor for any e$penses incurred by the Town for OSirequired and to
work in con oil with this permit
regulations for permits as outlined in the y"Tower of South Windsor's maintenance th or repaid
familiar 'th and will abide 'by the rules and
' r s (Pavement Cut Regulations )
Sigrid
APPROVED: DATE
APPROVED:
Suet.of ighways _"`�--- Engineer
.,r�. .. DATE
Town ineer
FOR INSPECTOR: Date work started
Suf x�ient riotifieat7.ion .received: yes no Date Completed
Unusual conditions encQun"tered � -
ea m=_." p
ype of repair: Per T`e .........
$lit�s attachar1! -
Ys-- Prxv- a .e or Perma
ent repair
Signed
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