HomeMy WebLinkAboutWater Street Cut Permits 31 Beldon Road ... .. /. ..:a.�,. .,.�t BZ{: .:.:i, ` ... _. , w¢'#�t`�7yer1..-a x..•i. .. ..
BOND TOWN OF SOUTH WMSOR
Am't Req. Q PUBLIC WORKS DEPARTMENT Date
` TOWN HALL.
t on i o: Permit No.
SOUTH WINDSOk Cr 06074
Date of Expiration 6- - Permit Expires -S-
APPLICATION FOR PERMIT
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Name and address of applicants; f - ,_ Phone No
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Location of proposed work
es//cribe. fully rfature of permit requested
Insurance on file with-- own yes no Date policy expires
Name of Insurer
o Approximate time for completion :: esired starting date
Call before you dig ticket 210.
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Show sketch of proposed work or furnish Z copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
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4 Applicant is responsible for contacting the Police Deparunent 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 famillar with and will abide by the' rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations,)
1
Signed
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APPROVED: DATE APPR"E DATE/
Supt. of Highways Town ngineer
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