HomeMy WebLinkAboutWidening of Clark Street Street Cut Perm car r.•`
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sQNRt T(yWN OF Q ,JTH W D OR 935
Re kPVMUC VirO tKS DEPA 1"
.9•_ Date
TOWN HALL
't on,FiIE 1540 SULLIVAN AVENUE F�er=n4t No.
SQUTH WINDSOR,CT 06974 ---
to of Ezpi AtiQn
APPLE'AVIM! ,�' F�ern�itExpire RMIT -- N
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Name and address of applicant , 4 Cnp Phone No., .
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Lacatipn o propose work,
Describe fully nature of permit requested ` f
insurance on file with Town yes no Date policy expires .-
c Name of Insurer ,
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o , Approximate -time for completion esired starttag Le y / 1 9 33
W- 1 before you dig ticket r% ZZ/6f p 7`!
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Show sketch,of proposed work or furnish Z' copies ,of sepaiate drawings w. '
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OSHA REQUIREMENTS MUST BE FOLLOWED
Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount_ of bond or deposit required and tq
reimburse the Town of South Windsor for any expenses incurred by the Town for maintmance or rep s<. ,-
work in coanectiou Withr this permit and that I am famfliar with and will abidehe r
relations for-permits as outlined in the Town of-South Windsors IPavenient nt egvlstions"
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Signed
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APPROVED DATE PROVED: DATE
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Supt. of Highways r 'To eer
FOR INSPECTOR: Date work started Ratep1ee - rT T
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u ficient. notification received: es no a of repair: Ferris. T `
Y YP p —�-1-ernp� �. . }..
Unusual conditions encountered
---- -----Mater-ial slips-attached:-yea. _no __ _- -Dated-for Permanentrepair
Signed