HomeMy WebLinkAboutWater Street Cut Permits 488 Strong Road �- BOND TOWN OF SOUTH WINDSOR - " �90
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
mtt on File 1540 SULLIVAN AVENUE Permit No.
I SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION OR PERMIT
FEE
Name and address of'applicant Phone No. '
Location of proposed work
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Describe fully nature of permit requested.
Insurance on file with Town yeses no Date policy expires
Name of Insurer
oApproximate time for completion i r7 Desired starting date
u Call before you dig ticket i4o. `-j t j
-4 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. 7H t
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. DATE APPROVED: ' . DATE ,l // f '/'
Supt. of Highways T�, n in
FOR INSPECTOR: Date work started -/ Daie completed
of icien 2n i'fica�iori-received: yes no T ype o jepair: berm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
.,: F Inspector E