HomeMy WebLinkAboutGas Main Street Cut Permits 310 Beelzebu T VOFsc uTH R 0971
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TOWN HALL Dta
1546 SUL,LIV" (►VENUE
Permit No.
Mete of Expiration SOUTH aG'INDSOR, CT,06074
- APPLICATION R ..PERMITr4 'mit E
FEE
Name and address of applicant ,
c' Phone No.
Location o proposed:work
Describe fully nature of pe,rrnt "requested
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Insurance on —file with Tow; n es no -
Name of Insurer - -'� ate policy a es
oApproximate time for pletion
Call before Desired starting to _You dig diq. ticket T1o. q�g���-�r- _ s
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a Show sketch: of proposed work or. furnish 2 copies Hof sepaiate d a
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OSHA REQUIREMENTS MUST BE FOLLOWED
fr APPlicant is reaponsibk for contacting the Ponce Depantnent and CALL BEFORE YOU DIG.
iI agree to furni3h to the Town of South Windsor the amount of bond t; reimbur
se the Towrn of South W nd .or deposit' requuri and
Bork in connection with this ge�nit. and any ezpenaeafamilr wit incurred by.h Town for'maintenance � ,
PIS
lations for that I am and �qi0 abide �b permits as Oudined in the Town of South Windsorr s (pavement Cut y � ' <"
1galatios ) _
Signed
APPROVED; DATE APPROVED: ,
Supt. o Highways DATE
L- Town Engineer
FOR INSPJz<CTOR: hate work started
d' nt not icatio Dateorx� leted
unusualconditions encountered_ YP�.o repair: Perm. '
emp.
Material slips attached: yes no Dated for �rni&nent repair
Signed
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