HomeMy WebLinkAboutElectric Street Cut Permits 201 South Sa BOND TOWN OF SOUTH WINDSOR N 391
Alm It Req. PUBLIC WORKS DEPARTMENT
rDate It on File TOWN HALL
1540 SULLIVAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant L Phone NO.
Location of proposed work ,
. ....
711, ,", 7..................
-141 7 -;-t . ............
Describe fully nature of permit requested
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Insurance on file with Town yes no Date Policy expires
Name of Insurer
.0 Approximate time for completion --j
<- Desired starting date
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Show sketch of proposed work or furnis 2 copies of separate drawi P4 ngs
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LApplicant 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 APPIRC!:V
St;p-t. of-Highways io7k I ATE
To n 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