HomeMy WebLinkAboutWater Street Cut Permits 300 Avery Stree - BOND TOWN OF SOUTH VaMSOR N2 10 2 9
Arn't Req. PUBLIC WORKS DEPARTMNT
Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE r -!S
Name and address of applicant aI W-„ ) Owl c Phone No
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Location of proposed work
Describe fully nature of permit requested
1
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Insurance on file with Town no Date policy expires
Name of Insurer _
0 Approximate time for completion Desired starting date
' Call before you dig ticket P1o. s
a. Show sketch of proposed work or furnish 2 copies of separate drawings
a
0
0
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0
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0
OSHA-REQUIREMENTS MUST BE FOLLOWED _.
a
p Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. r
a .
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 , aintenance or repair
work in con tfon With t ' permit and that I am familiar with and will bi by the rules and
regulations f per Re ad c�Clined in :Town of South Windsor's (Pa v C( t Regulations.)
Signed a
APPROVED: DATE APPROV ATE
Supt. of Highways T Egger
FOR INSPECTOR: Date work started Date completed
Sufficient note ication received: iyes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material•slips attached: yes no} Dated for Permanent repair
Signed
Inspector _.