HomeMy WebLinkAboutRepair snet cable Street Cut Permits Tal BOND TOWN OF SOUTH WINDSOR 091-15
Ain't Req. PUBLIC WORKS DEPARTMEW Date
TOWN HALL
't on File. IW SUL11VAN AVENUE Permit No.
Date of Expiration SOUTH WINDSOR, Cr 06074 Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of applicant Phone No. <�:,
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town ye,s- no Date policy expires
Name of Insurer
0 Approximate time for completion Desired starting date
Call before you dig ticket r4o.
Show sketch of proposed work or furnish Z copies of separate drawings
0
0
0
(U
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0
0
OSHA REQUIREMENTS MUST BE FOLLOWED
CL
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.)
Signed
APPROVED: DATE APPROVED: - DATE
Supt. of Highways !Town 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