HomeMy WebLinkAboutConduit Street Cut Permits South Satelli BOND TOWN OF SOUTH WINDSOR 468
Am't Req. f PUBLIC WORKS DEPARTMENT
N HALL Date
m't on File 1540 SULLIVANO AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant Wl<TAir:r6F,;,,,f� 0:,.kjs� (r !
I �,� ��, {i Phone No. ��%-52zy
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Location of proposed work
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Describe fully nature of permit requested_ /�
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Insurance on file with Town es no
Name of Insurer 1 Date policy expires .3) .
o Approximate time for completion T AA WA` a-,'
,r, p I J.f t De/sired starting date If, 24.
Show sketch of proposed work or furnish 2 co
a pies of separate drawings
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Applicant 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.
APPROVED. DATE
APPROVED: - DATE Supt. of Highways Town g
neer
FOR INSPECTOR: Date work started
no
Sufficient noti fication received.' es T Date completed
Unusual conditions encountered y ype of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector