HomeMy WebLinkAboutSewer Installation Street Cut Permits 19 BOND TOWN OF SOUTH WINDSOR � 474
Am't Req. PUBLIC WORKS DEPARTMENT
Da
TOWN HALL Date
Am't on File 1540 SULLIVAN AVENUE
` Date of Expiration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE $10.00
Name and address of applicant �_�. ,
G v Z 1) S P c f" < — C , Phone No. 5 6 - C> 2 f U
Location of proposed w rk
Describe fully nature of permit requested
Insurance on file with Town yes no Date policy expires
Name of Insurer 7 u .S (^ �-
o Approximate time for com letion /— - —
Desired starting date — —
u Show sketch of proposed work or furnish 2 copies of separate draw'
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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
work in connection with this permit and that I am familiar with and
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
, 'the rule
regulations for permits as outlined in the Town of South Windsor's ( will abide by s and
Pavement Cut Regulations)
,4
Signed '
APPROVED: DATE APPROV
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-.attac-hed-. ye-s----no Dsted-for Permanent repair
Signed
Inspector