HomeMy WebLinkAboutUnderground utilities/cut road Street Cu BOND _ TOWN OF SOUTH WINDSORr= � s
Am It Req. PUBLIC WORKS DEPARTMENT
)0 . '"' TOWN HALL Date
t on File 1540 SULLIVAN AVENUE 71
Permit No.
Date of Expiration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires`-i t>
FEE $10.00
Name and address of a pli ant -
Location of proposed work
Describe fully nature of permit requested
bUtia
]assurance on file with Town yes Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date >:
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v Show sketch of proposed work or furnish 2 copies of separate drawings
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2
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QApplicant 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 requir nd to
reimburse the Town of South Windsor for any, expenses incurred by the Town for main' o repair
work in connection with this permit and that I am familiar with and will abide by t es and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regul io )
Signe
APPROVED: DATE
APPROV D• r'
Su t. of Highways DATE
p '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