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HomeMy WebLinkAbout6 lateral Street Cut Permits Victor Lane BOND TOWN OF SOUTH WINDSOR N® ; 774 Am't Req. PUBLIC WORKS DEPARTMENT y TOWN HALL Date '#on File 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 Permit No. Date of Expiration APPLICATION FOft PERMIT Permit Expires FEE S/O.O Name and address of applicants , phone No. Location of proposed work ,� S , � , Describe fully nature of permit requested�` Insurance on file with Town yes no Date policy expires Name of Insurer ..T o Approximate time for completion Desired starting date u Call before you dig ticket iJo. aShow sketch of proposed work or furnish 2 copies of separate s drawin g04 �C.Q!r'f.( c .. 1� :,, G •got!' -ce oVo a l�t l�h� 0 o �7 `C i 0 Applicant is responsible for contactin th Police p rtme t an ALL 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 r ,APPROVED. DATE APPROVED: Supt. of Highways T DATE 1:_ own Engineer FOR INSPECTOR: Date work started Date completed Sufficient notification received: —yes_ _. _ ._n©=. _,.. ._._T e--of--r - .__ iFfl epar:-Psi;`FTnusual conditions encountered Material slips attached: yes no Dated for Permanent repair Signed Inspector- j.