HomeMy WebLinkAboutdrain layer permit 710 Governors Highway BOND TOWN OF SOUTH' WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date 1k 19-7¢
MUNICIPAL BUILDING Tr
Am't on File 1540 SULLIVAN AVENUE Permit No. 17
SOUTH WINDSOR, CONNECTICUT
Date of Expiration Permit Expires
APPLICATION .FOR PERMIT
FEE $10.00
Name dress of pplicant one No.
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Location of proposed work
Describe fully nature of permit requested
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Insurance on file with Town yes no Date policy expires
Name of Insurer
oApproximate time for completion Desired starting date
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4 Show sketch of proposed work or furnish 2 copies of separate drawings
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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 Re lations.)
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Signed U o vz -V .0
APPROVED. DATE APPROVED: DATE
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector