HomeMy WebLinkAboutElectric Street Cut Permits 35 Stephanie BOND
TOWN OF SOUTH WINDSOR 460
Am't Req. PUBLIC WORKS DEPARTMENT
[Date
t on File TOWN HALL1540 SULLIVAN AVENUEate of Expiration SOUTH WINDSOR, CT 06074 ermit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant .
, 4` Phone No. t
Location of proposed work t
1110
Describe fully nature of permit requested Insurance on
rfile with Town
yes no
� Name of Insu er Date policy expires
o Approximate time for completion
rt Desired starting date_ _1
Fhosketch of proposed work or furnish 2 Copies of
a
� P separate drawings
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O
0
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4" a
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a ,.
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
reimburse the Town of South Windsor for any expenses ivcurred by the Town for maintenance or re to
pair
work in connection with this permit and that I am f regulations for permits as outlined in the Town of South Windsorar ts (Pavementh and Cute by Regulations.)therles and
Signed €_-
APPROVED: DATE
Supt. of Highways APPROVED: ,' f DATE
Town Engineer
` FOR INSPECTOR: Date work started
Sufficient notification received: yes no Date completed
Unusual conditions encountered Type of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector