HomeMy WebLinkAboutWater Street Cut Permits Avery Street at (2) , 8° D TCJWN O 9(?R
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Req. FVBI44 WU `
rY It on File ; TO'�ly,H
1540 SULUVAN AVENUE
SOUTH WINDSOR,CT 06074 Pea•mit No.
Date of Expiration i
APPL CAT�O Fermit.Expir'a
FEE OR ?VRMIT ° . '----�-----r°'
Name and a dress of licant
Rhoa N
ocation o proposed wor
- r 1
Des:cri a ally nature of permit requested
Insurance on file with Town es o
Name of Insurer Y ate policy expires
:o Approximate time for completion Desired
Call before starting to
u YOU- dig ticket tio.
-Show sketch of proposed work or: furnish 2 copies of sepairate drawin
$s
Q
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o -— - TFqOLL;OWEI)
u OSHAREQUIREMENTS s,
Applicant is respon ibk for contacting the Police Depantnenr and CALL BEFORE YOU DIG.
1 a to fure�iah to the Town of South Windsor r,
the .amount`of bond reimburse the Town of South,Windsor for an expenses nd "or deposit req
work ih cannF�ctioa with this Y Pe1a incurred,by the`To ►n for-mflintene�nce or Lair
regulations for Pit_ that I am femgiar with aad mill abide" by the '' h
is as nu the Town of South M rubs a�
l dined is
s IPaventent.;Cnt Rgn>titio,
Signed x
r
APPROVED: DATE
APPROVED: 1 DATES /-
5upt. o H 6 aYs n rN
y Town . sneer t .4
FOR INSPECTOR:
Date work started Date completed }u fic it ent,hots ,cation:received: es no Y ype of repair: Porno. p
Unusual conditiOn�s encountered Ti
Material slips.at tacit
ad:- yes -'no ated for Permwnent repair:
Signed ~