HomeMy WebLinkAboutConduit Street Cut Permits Strong Road/B BOND TOWN OF SOUTH WINDSOR '4 450
Am't Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00 .1
Name and address of applicant �(J,.,-�/
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Location of proposed work f
Describe fulmar natur of permit requestedt-
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Insurance on file wit Town �Zre J no Date policy expires il� • �-Name of Insurer 7-
0 Approximate time for co m le on
p Desired starting date
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Show sketch of proposed work or furnish 2 copies of separate drawings
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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.)
Si ne ! ('/!
APPROVED. DATE
APPROVED: / DATE. 1;
Supt. of Highways e:.� To —n ngineer
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