HomeMy WebLinkAboutReplace service Street Cut Permits Woodl � BOND W N-0 156 .
TOWN OF SOUTH WINDSOR
A �t Req. PUBLIC WORKS DEPARTMENT Date
x, �oft TOWN HALL
an't on File ` _ 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
date of Expiration f
APPLICATION FOR PERMIT Permit E�ires
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Name and address of a licant ✓
PP Phone No.
Location of proposed work,y
Describe fully nature of permit requested.
Insurance on file with Town - -yes - no Date policy expires
Name .oi`Insurer
o Approximate time for completio Y' _ Desired starting date
u Call before you dig ticket No
Show sketch of proposed work or furnish 2 copies of separate drawings
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Applicant is responsible for contacting the Police Department aiid GALL 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
regulatios for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Si��g ned ' _ ),
Al?PROVED: DATE APPROVE ,% �w Supt. ofFIighways DATE />f-i i
,
/To n n er
FQR NZ
INSPECTOR:' Date work4
started �- Dane completed
Sufficient notification received:_�-e _..� nn _ y__ a o#�
IInusua-�conditions encountered Ptrrn:
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Material-slips attached: -yes no Dated for Permanent repair y f
Signed
Inspector