HomeMy WebLinkAboutMan-hole for SNET Street Cut Permits Buc TOWN Off' SOUTH WINDSOR 5
.A►raa'tteq PUBLIC WORKS`D 'ART1tiIENT
Date
Ainit on File TOWN HALL �
F 1540 SULLIVAN AVENUE
a a of Expi,nation
SOUTH WINDSOR, CT 06074 Permit No.
f f. ' ------- APPLICATION FOR HERMIT Permit Expires.
FEE s10.00
,yY - -. ,
1`Trne�.and addre-ss of a plica.nt (j t
. �� �V� + �+4`f� �w5�phoneNo.
Location of propQ ed work Y�'►27`�-� b 1 '
Describe ully nature of er *fin 0
permit requested
neurance- on file with Town yes no Date Policy
` Name of Insurer P y expires
' >r A
PProxmate tinne,fpr completion Desired starting date
Ca11 befoie you da Q° cket Yqo
a; Show sketch of proposed work or"fUrnis / �±
h 2 copies of separate drawings
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..Y
Applicant is responsible for contacting the F61ke Department and CALL BEFORE YOU DIG.
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 4ny gXpenses incurred by the Town for maintenance or r
wor m connection with this permit and that'I am familiar with and will abide t the rules repair
regltions for permits as outlined in the'Town of So
uth Windsor's (Pavement Cut Regulations.)
L
Signed
APPRUVED: -:DATE APPROVED:
. 8upt. of Highways DATE�;;• �,, ,
t l T Engineer
Town ---
4 F: R INSPECTQR: Date wtrork. started
bcl#ent notification received: yes'
Date completed
U us. Y no_ a of re
MAtet►ial slips attached es no Y ated for Permanent repair