HomeMy WebLinkAboutWater Street Cut Permits 675 Clark Stree "s - F,;ec" •-•Z. �.:...+e.. .msa3-p,.�.r;:�, +,'�!:"u�;Z"'=^�ePvrr�'A+'�r
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It on File
`1540 SULUVAN"AVENUE Permit No.
SOUTH=.W1ND$Oli,;CT'Q6074
12atO of Expation "; Permit Expires
APPLICATION FOR PERMIT
FEE $10.00
Name and address of applicant* ; C!► Phone No. old 1i-`i '2.q
JbA F=,;_ke0. W1- Zis Wcs Lor I;n c,» C ' �.(o ?g
o'cat on of propose work l `ncl __.ten
Describe full nature of ermit requested' ,,
Y Pra e. 1 c,-1 e r� t 1L cru`c:l
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Insurance on filewith Town s no Date policy expires L1--
- f Insurer Narn.e o ,.
i APProx ate time;rse ' c m leti ri �/-.24a ��^Desired L
istarti date
Call before" you d } cltet No.
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Show sketch of proposed--`work or furnish 2 copies of separate drawings
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Applicant is responsible for-contacting the Police Depa tr ment and CALL BEFORE YOU DIG.
I :agree"to- fornish to the Town of South Windsor the amount of bond or deposit required and to
" reimburse the Torwni of South-Windsor for any expenses"incurred by the Town for maintenance or repair
wort, in connection with this permit and that I am familiar with and will abide by the rules and
regg�tions for permits as outlined in.the Town of South. Windsor's (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVED: , DATE
"Sup!. of Highways ' fi' Town Engineer"
FOR INSPECTOR:` Date work started_ Date completed
f-ii�rrt Doti toneed; 8. _:.no .�_ Type of repair-- Perm
Unu ual conditions, encountered -
- Material slips attached: es rya Mted for ekma.nent'repair
" •Sitgned