HomeMy WebLinkAboutReplace cable TV Street Cut Permits Skyl } BOND TOWN OF SOUTH WINDSOR NO - 7 8 6
Am It Req. PUBLIC WORKS DEPAATMENT
TOWN HALL Date`
rn't onFile ? a 1540 SULLIVAN AVENUE
Perrhit,No.
Date of Expiration
SOUTH WINDSOR, CT 06074
APPLICATIO OR PERMIT Pe, it Expi3ps
FEE
Name and address of applicant I j, S ho
Location of proposed work
Describe fully nature of permit requested.
Insurance on file. with Town iyes� no Date policy expires
c Name of Insurer
o Approximate ti pn �„i
Q Desired starting
u Call before you dig ticket 14o.
Show sketch of proposed work or furnish 2 `
a 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 req uired 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 i'or permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVED:
Supt. of Highways / DATE
Town Engineer
FOR INSPECTOR: Date work started
Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed .
Spector