HomeMy WebLinkAboutRepair walks Street Cut Permits Windy Hi BOND TOWN OF SOUTH WINDSOR 2 807
It Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
Date of Ex piration SOUTH WINDSOR, CT 06074
APPLICATION FOR PERMIT Permit Expires
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Name and address of applicant i r k - Phone No.
Location of proposed work n �i
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Describe fully nature of permit requested.
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Insurance on file with Town no Date policy expires
Name of Ins urer- �-%,: ;� �
oApproximate time for completion ,� Desired starting. date - -'--
Call before you dig ticket 14o.
Show sketch of proposed work or furnish 2 copies of separate drawings
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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 APPROVEDc DATE
Supt. of Highways Town Eft neer
FOR INSPECTOR: Date work started Date completed
Suffi ratification=r�6ev�dT= esr- _- _gym ..._..__Te=af r�p�YPerm. Temp. L
Unusual conditions encountered
Material slips attached: yes no Date for Permanent repair
Signed
Inspector