HomeMy WebLinkAboutDrainage system Street Cut Permits 99 Sy BON
D TOWN OF SOUTH WINDSOR - - 751
FAmt Req. PUBLIC WORKS DEPARTMENT
TOWN HALL Date
rn't on File 1540 SULLIVAN AVENUE
Date of E*piration
SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION OR ERMIT Permit°�cpires
FEE O - �.
Name and addres of applicant Apr `'�'�
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Location of proposed work,
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Descri a fully nature of per it equeste63 0—
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Insurance on file with Town r
yes no Date olicy xpires ~G
� Name of Insurer-
o Approximate time for completion ?��
Call before you dig ticket iJo. esired starting ate
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Show sketch of proposed work or furnish 7�,
copies of separate drawin s
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QApplicant 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 j'Pavement ;Cut`Regulations.)
Signed
APPROVED. DATE APPROVED:
Supt. of Highways DATE � y/
p Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: es
Unusual condition s_enc-ount zee -----y now Type of repair:-.Perm.
Material slips attached: yes�no Dated for Permanent repair
Signed
Inspector