HomeMy WebLinkAboutWater Street Cut Permits Smith Street/Wh BOND TOWN OF SOUTH WINDSOR No
843
Am It Req. PUBLIC WORKS DEPARTMENT
TOWN HALL FDaAm't on File 1540 SULLIVAN AVENUEDate of ExpirationSOUTH WINDSOR,CT 06074o.
APPLICATION ,I OR PERMIT Permit Expires
FEE
Name and address of applicant
r; Phone No.
Location of proposed work ,
Describfully natu{e gf;permit requested. 2gA .
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Insurance on file with Town yes no Date policy expires
Name of Insurer --
o Approximate tune for completion Z Desired staxting date c�-2
u Call before you dig ticket ido.
adrawings
Show sketch of proposed work or furnish 2 copies of separate --
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Applicant is responsible for cont cting the Police Department and CALL BEFORE YOU DIG. 1`-'tl1Et
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
regulations for permits as outlined in the Town of South W
work in connection with this permit and that I am familiar with and will abide by the rules and
indppor's (Pavement Cut Regulations.)
11
,i
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
Inspector