HomeMy WebLinkAboutRenew water service Street Cut Permit 29 BOND TOWN OF SOUTH WMSOR Na. 1031
Am't Req. PUBLIC WORKS DEPARTUMT
TOWN HALL Datd
't on:File 1540 SULLIVAN AVENUE
J SOUTH WINDSOR, CT 06074 Permit No.
Date of Expiration ---'—
APPLICATIO FOR PERMIT permit Expires-
FEE
Name and address of
Phone No.
Loca ion o propose .applic4ant
Describe fully nature of permit requested
d- Mill
Insurance on file with Town es no ale. olic e
Name of Insurer P Y xpires
oApproximate time for completion
.. esired starting date
u Call before you dig ticket Pdo.
Show sketch of proposed work or furnishC copies of,separate drawings ---_1
o
0
x
u
o
*A
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OSHA REQUIREMENTS MU T BE FOLLOWS04 a
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 regulations for permits as outlined in the Town of South Windsor's (Pavement Cut by the rules and
Regulations.)
Signed
La"69"0.—
APPROVED: DATE APPROVED:
Supt. of Highways DATE'' ' •p7-
.- Town Engineer
i FOR INSPECTOR: Date work started
gulf icient noti ication "received: es no Date completed
Unusual conditions encountered Y ype of repair: Perm. Temp.
Material -4ps attached: yes no Dated for Permanent repair
Signed
spector j