HomeMy WebLinkAboutWater Street Cut Permits 370 Beelzebub R BOND TOWN OF SOUTH wmSOR
It Req. t V airic WOPM DEPARTMN'T Date
TOWN HALL
it on File
1540 SULLIVAN AVENUE Permit No.
SOUTH WDMWR,CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEB f)e
Name and address of•applicant '
r one No,] -(1, �._X
Location of, proposed work a _
Describe fully nature of permit requested
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Insurance on file with Town 1CSs Name of Insurer no ate policy expires
c
o Approximate time for completion esired starting tee
Call before you dig ticket No. °C Y L( Lt L1
aShow sketch of proposed work or furnish 2 copies of separate drawings - --�
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10 '
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OSHA REQUIREMENTS MUST BE FOLLOWED
a
Applicant is responsible for contacting the Police Depantnent and CALL BEFORE YOU DIG.
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 expanses in red by the T wn for ce or repair
work in connection 17h pernai t a � Il �b rnl p
regulations for permitsn- �iTown o govth �y' es and
,. mdgr s (Pavement Cut RQns.1
guht
,,Signed
APPROVED. DATE APPROVED. DATEt � .. �
Supt. of ighways T n or
FOR INSPECTOR: Date.work started
Date completed
S2ficient Hoff cation received: yes no, Lrepaiv_ Per
nusua conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
spettor