HomeMy WebLinkAboutWater Street Cut Permits 310 Beelzebub R } BOND TOWN QF SOUTH �VIDQR. 1006
't Req." PUHI.iCWQRK� DEA�L'7N'P "
Date
TOWN HALL
It on File 1540 SUU IVAN'(VENUE Permit No. '.
SOU M WINDSOR,CT 06074
Date of Expiration
APPLICATION 9;OR`PERMITLPermit:permit Expires
FEE _ /G� --►-
Name and address of applicant ;o le ,M'tlrr rrt
L ome No: y�
r'IN n f }{ -� .
Location o p opose work
Describe fully nature of permit requested
• ,/�S_�.4 /� 1,�.�;��.� 1 . Lam.
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Insurance'on file with Town yes no ate policy expires
Name of Insurer ~-
Approximate time for completion Desiredstart ng' to t
Call before you dig ticket lio. I ,�
d. Show sketch:of proposed work or furnish 2 copies of sepa#ate drawings
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e
aO$HA REQUIREMENTS MUST BE FOLLOWED '
PP k for contacting the Police Deparanent and CALL BEFORE YOU DIG.
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h to to the Town of South Windsor the amount of bond or deposit regwred and to
�imb :South Windsor for any expenses incurred by the Town for n�efuntenadce or
s ►otlr o WiEh this P�erneit and that I am
letlos fgunftr with and win abtik by the ruaes�
<. -*� +fur in the Town of South 11 iNdsor's IPave nt:Cs -
G4 , Rsgnlaato,�s.)
3 n��r 4-
Signed :
t ` APPROVED: DATE APPROVED; DATE"
Supt. of Highways �' Tov�v�g near
.FOR INSPECTOR: Date work started Dateo=npleted
u ficient' zzoti ' do
-ho Loh
Unusual :conditions encountered
Material slips attached: yes no Dated for" ermanent repair
Signed