HomeMy WebLinkAboutWater Street Cut Permits 766 Clark Stree T W N2
O N OF SOUTH WINDSOR
Arn't Req. PUBLIC WORKS,DEPARTMENT Date 1%C.:
TOWN HALL
az5g It on,File 1540 SULLIVAN AVENUE Permit No. .;
SOUTH WINDSOR,CT 06074
Date'.of Expiration Permit Expires
. APPLICATION FOR PERMIT
FEE $100 ' / c�. =' 2 73
Name .and address of applicant,_. L i H 6 F,r, , _Z ,Q, Phone No 7
Lpcafion of proposed work 7E
Aescribe -fully n ture,of per requested` • c-, r t ,�• , t� ,;,, t• t
1 �. -!
ir Cr...>frY G �.� 7l.e',
( nsuran'ce on, file with Town yes no Date policy expires ; a
r Name of Insurer'
p Approximate timeo�r cornpletiond Desixed staxxng date -/ L Call M ds.ore you g t &et No. =
t o
34 Show sketch of proposed work or furnish•2 copies of separate drawings
F Os
t O 7�
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44
A.
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0
Applicant Is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree t6 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
regulations for permits as "outlined. in the Town of South Windsor's (Pavement Cut Regulations.)
Signed r'
APPROVED: DATE APPROVED: + ATE
Supt. of Highways. Town Engined?'
FOR INSPECTOR.: Date work started Date completed
�,-.,..-._:-'� - Su<f-f-i��e-pit-notif�e✓a:tron—neee-i-v�c��-.:des--•--�-no-°. '1'YP:e-of--repar --Perm-: � ..�._-- -
Unusual no ditions encountered'
Material slips attached: yes . no Dated for Permanent repair
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