HomeMy WebLinkAboutGas Street Cut Permits 40 Victor Lane BOND TOWN OF SOUTH WINDSOR N2 - - 777
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
mtt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration
APPLICATI OR PERMIT Permit Expires
FEE /�
Name and address of applicant Phone No ,�_. ��
Location of proposed work CTr.),f, CA
Describe fully nature of permit requested. rdJJ7 �, 7A.S
Insurance on file with Town es no Date policy expires /
Name of Insurer �?�;�`
o Approximate time for completion / Desired starting date 8 ��
rd Call before you dig ticket lJo. 913 QS/B 3
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aShow sketch of proposed work or furnish 2 copies of separate drawings
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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 (Pavement Cult Regulations.)
Signed
APPROVED: DATE APPROVED:_ DATE Supt. of Highways
Town Engi eer
FORINSPECTOR: Date work started
Date completed + :.
Sufficient notification receive:
Unusual conditions encountered .v
Material slips attached: yes no Dated for Permanent repair
Signed
spector #_