HomeMy WebLinkAboutWater Street Cut Permits Strong Road BOND � TOWN OF SOUTH WINDSOR N? 388
Am t Req. ;*_ PUBLIC WORKS DEPARTMENT 1
.-� TOWN HALL
Date �� °- /
m t on File - 1540 SULLIVAN AVENUE
Date of Expiration �-
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATIOOT - --R PERMIT Permit Expires
FEE $10.00 w
Name and address of applicant
C' C C" hone No.
Location of proposed work
Describe fully nature of permit requested '
Insurance on file witIiI Town I Ajia no
Name of Insurer Lo Date policy expires
o Approximate time for com etion '
Vp T Desired starting date N �
Show sketch of proposed work or furnish 2 copies of separate drawings
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04 Applicant i s 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.)
Sig
APPROVED: DATE ,-� -'�
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Supt, of Highways � - DATE
Town Engineer
FOR INSPECTOR: Date work started
Sufficient notification received: yes no T Date completed
Unusual conditions encountered ype of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector