HomeMy WebLinkAboutGas Main Street Cut Permits Sharon Drive BOND TOWN OF SOUTH WINDSOR o 791
Am't Req. PUBLIC WORKS DEPARTMENT Date
J TOWN HALL
m't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE /4-
Name and address of applicant y/fiVl< t Phone No., �2. /- 1 k
Location of proposed work_�_�,g,�a„�
Describe fully nature of permit requested. Z yf= G ,As A G
Insurance on file with Town (e no Date policy expires q L
Name of Insurer ,/s
o Approximate time for completion w k. Desired starting date
Call before you dig ticket P1o. _`1/±
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 DtJ /'L.JI,4
APPROVED. DATE APPROVED:/ jf-) DATE_jG!
Supt. of Highways pgp Town Engineer
`-'FOR INSPECTOR: Date work started Date completed ed
Sufficient notification received: yes no Type of repair: Perm, Temp.
- Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector