HomeMy WebLinkAboutSewer Installation Street Cut Permits 46 1
h aoivD TOWN OF SOUTH I MSOR
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tea'"t Req. PUBU W'O S D ART1 :NT Date
TOWN 14ALL
an hilt 1540 SUi.t.tvniv !,VENUE
Kermit Noy
SOUTH WWbSOR,CT 06074
Ate of Expiration Oermit Expires_
APPLICATI FOR PERMIT
FEE '
{ Name'and address of applicant?"�,rt fA[,IFc�R �/��ps Phone PTO.
Location o proposed.work ; �
Describe ally nature of permit requested t. << � .
Insurance on rile with Town es no ate policy exp'res
c Name of Insurer
o App.'roximate time for completion rx 9 3 Desired starting a /r
Call before you dig ticket 14b. 93
Show sketch of proposed work or. furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
Applicant is responsible for contacring the Police Deparnnent and CALL BEFORE YOU DIG. r
.I agree to furnish to the .Town of South Windsor the amount of bond or depo:fit required end 14 ,
reimburse the Town of South Windsor for any expenses incurred by the Torn for maintenance or repur
work in connection with this permit and that I ara. familiar with and will abide. by the
regulations for permits as ou lined in.the�Town of.South Windsor's (Pa' t Cnt -
liegulations;
t Signe
APPROV-ED; DATE APPROVED: ` . _DATE -�
Supt.. of Highways p4;,;x Town Engineer
j FOR'INSPECTOR: Date work st
arted arted Date completed,
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15ufficieimt noti ication received: yes no Type of repair: Perm. Temp.
Unusual iconditions encountered
Material slips attached: yes no Dated for ermanent repair
Signed'.. - - ,
hi
epector "`