HomeMy WebLinkAboutWater Street Cut Permits 748 Clark Stree w.- . (( N� 730
Bonn TOWN OF SOUTH WINDSOR
='JA:' 't Req. PUBLICWORKSDEPARTMENTDate /,�- /�TOWN HALL
n File 1540 SULLIVAN AVENUE
Permit No.
SOUTH WINDSOR,CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of'applican Phone No. 7
Location of proposed work
Describe fully nature of permit requested. "_[
2w
Insurance on file with Town yes no Date policy expires . 3 J• �"f
� Name of Insurer //j 4o �r
o Appro�timate time for completion Desired starting ate
Call before you dig ticket 11o.
a Show sketch of proposed work or furnish 2 copies of separate drawings
o.
ed
O
O =
C` 14
Y a -
a�
y
G, '.5F VICLr
o r �.
.04
I 4 AppEitant is responsible for contacting the Police Department and�ALL BEFORE YOU DIG.
L. 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 expenses incurred by the Town for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by .the rules and
i regulations for permits as outlined in the Town of South(,Windsor's (Pa ment Cut, Regulations.)
Signed
APPROVED: DATE APPR' ED: " , � ! j;•�� DATE
Supt. of Hi, ways Town Engineer
FOR INSPECTOR: Date work started Date completed
- Su ficieitt"notification received: ..yes. no Type of? repair: Perm. Temp.
Unusual- cohditions encountered
Material slips attached: yes no Dated for ,Permanent repair
Signed
.1as ecto �,