PERMIT NO - Windsor, Connecticut
PERMIT NO.
Date
Permit Fee
Starting Date
Permit Expires
(2 months after Starting Date)
Issued By
TOWN OF WINDSOR
ENGINEERING
275 BROAD STREET
WINDSOR, CONNECTICUT 06095
APPLICATION FOR PERMIT
PERMIT TYPE
Street Excavation Driveway
INSURANCE EXPIRATION DATE CALL BEFORE YOU DIG
LICENSE NO. 1-800-922-4455
BOND ISSUE DATE No.
COMPLETE THIS SECTION
Address of proposed work
Applicant’s Name Utility
Address
Office Tel. No. Emergency Tel No. (Different from office)
Name of Property Owner
Describe nature of permit work
Is the work adjacent to or involve the Town’s sidewalk? Yes No
DRAW SKETCH SHOWING: EXISTING LAYOUT, PROPOSED WORK, AND DIMENSIONS:
**Authorization is required from the Town Forester of any tree location on Town Property is to be removed or disturbed by proposed construction (285-1884).
The applicant understands and agrees that all work shall conform to the rules, regulations and specifications of the Town of Windsor, Engineering Standards and Specifications and to maintain the cut pavement with a temporary patch, to restore the pavement as required including maintaining the pavement repair for five years, to reimburse the Town for all costs incurred by the Town for repair work in connection with the permit and to indemnify and save harmless the Town from all damages caused by acts or omissions while acting under the permit.
PERMITTEE MUST NOTIFY THE ENGINEERING CONSTRUCTION INSPECTOR, 2 WORKING DAYS PRIOR TO STARTING THE WORK. PHONE 860 285-1876.
PERMITTEE SHALL COMPLY WITH THE “PROCEDURES TO BE FOLLOWED FOR ROAD CLOSING AND TRAFFIC CONTROL”. SEE BACK OF THIS PAGE.
Print Name___________________________________ Signed Date
Title
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