HomeMy WebLinkAboutRepair broken water main Street Cut Perm (2) BOND TOWN OF SOUTH vAms R
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL,
it on File IW SULLIVAN AVENUE Permit No. ZoQ
SOUTH WINDSOR,CI'06074
Date of Expiration APES ICATION�FOR PERMIT Permit Expires
Name and a dress of: p licant " ,
Phone Noy
Location of proposed work
Describe fully nature of permit requested
Insurance on file with Town yes _ no Date policy expires
c Name of Insurer --
o Approximate time for completion 0 V Desired starting date E+t
Call before you dig ticket M.
q4 1 —
Q. Show sketch of proposed workor furnish 2 copies of separate drawings
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Coz VA
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4 OSHA REQUIR *ENTS MUST BE FOLLOWED
Applicant is responsible for contactin }tie Polim Department and CALL BEFORE YOU DIG.
I agree to furnish to the Towd-of South Windsor the amount of bond or deposit required and' to
reimburse the Town of South Win4pw for any expenses incurred by the Town for maintenance or repair
work in connection with this Pernik and that I am familiar with and will abide by, the
rules regulations for permits as outlined in,.the Town of South Windsor's (Pavement Cut and
Regulations.)
Signed 1
APPROVED: DATE APPROVED: ATE �9
Supt. of ,ighways 0*ways
Z2�
FOR INSPECTOR: Date work started Date completed
u icient .noti ication received: yes Tj7pe of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
_ Signed
spector