HomeMy WebLinkAboutWater Street Cut Permits Wheeler/Smith BOND TOWN 'OF SOUTH WINDSOR 2 ' - 8 4 3
Am It Req. PUBLIC WORKS DEPARTMENT
Date Z_
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06o74
ate of Expiration
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of applicant r ^ Phone No
Location of proposed work
Describe fully natur permit requested.
// J NG 1 i t
Insurance on file with Town yes no "Date policy expires
Name of Insurer
o Approximate time for completion Z Desire44
d starting date Z..
Call before you dig ticket 11o.
aShow sketch of proposed work or furnish 2 copies of separate drawings
�d
w
O
—� pS � worl �reb�
w � �
�10
Ted
o r`
4-0
i
Q' LA:p'p 'canr is responsible for cont ring 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 Wind or's (Pavement Cut Regulations.)
Signed;-
APPROVED: DATE APPRO ED:
DATE
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started Date comp lete '
Sufficient notification receved _ ._y. . .. . _.no-.. .- - -T e o re. rr:-Perm
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector -"