HomeMy WebLinkAboutWater Street Cut Permits Strong Road/Gor r,,z
BOND TOWN OF SOUTH WINDSOR 363
Am't Req. PUBLIC WORKS DEPARTMENT
Date
m't on File N HALL
1540 SULLIVAN AN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant -
Phone No. ..
Location of proposed ork
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Describe full nature of
Y permit requested
Insurance on file with Town
Name of Insurer a
no Date policy expires
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O Approximate time for completion Desired starting date
Show sketch of proposed work ()r furnish 2 copies of separat04 e drawings
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14 b
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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: DATEVz
APPROVED:T 'u.�
Supt. of Highways ATE_
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