HomeMy WebLinkAboutWater Street Cut Permits 630 Strong Road ' 397
BOND TOWN OF SOUTH WINDSOR
Am't Req. /G 00 6 PUBLIC WORKS DEPARTMENT Date
TOWN HALL
m't on File —"' 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration -- Permit Expires
APPLICATION FOR PERMIT
FEE $10.00 tv R
Name and address of applicant az, ����� T,°PuC/�,,r� Phone No S �'
Location of proposed work _
Describe fully nature of permit requested
f It Insurance on file with Town Cyes no Date policy expires
Name of Insurer --
oApproximate time for completion Desired starting date
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.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.
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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 (Pav meat Cgt'Regulations.)
APPROVED: DATE APPROVED:-A,N- -
Supt. of Highways T wn Engineer
FOAg PECTOR: Date work started Date completed
_-----Euffic.Tent-n0tificatinn_rec.eixed: -.Ty_pe_..,of—r-epair-:._._P_ezm.----�exnp..__.�___.._
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector