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HomeMy WebLinkAboutTelephone and electric pole 247 Street C BOND TOWN OF SOUTH WINDSOR Am't Req. PUBLIC WORKS DEPARTMENT Date ze l;7 TOWN HALL . It on File 1540 SULLIVAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 e of Expiration Permit Expires APPLICATION FOR PERMIT FEE ,.'I © -" WI;u-s Romp - I.J�'rtt&lLsF, �� G{. o�tQ' Name and address of'applicant VJr-ti,F,2SFir,-"3 r os-i. Ca, T,-", . Phone No. 527-S224 .,� 661 CL,(Zj< S-reT7-rr CJ P-Q< *tom 24q C Location of proposed work ' Describe fully nature of permit requested. Ms-r � �, ,,,� �`r`�E, _1ZOID rr,OSSiA r.. S_ �l EtTirA IJixPTl1 D-r, -4ro _R-AO NzC©/(C?y2y77�ft an! SP't� p 61,1 s, S4a- -- 214 1 r Insurance on file with Town yes no Date policy expires 4..1•,7Z Name of Insurer_Tjr' AI1i2-7-man o Approximate time for completion 1 vjl= G Desired starting date 10 1, 9 1. { Call before you dig ticket ldo. A1391448 a Show s etch of proposed work or furnish'2 copies of separate drawings O 0 Wnl a �, Cute srCD 3a a� T 4 O ��ISTI '• IL� , ti4. r C!c 6 tt r 7d a Q 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 to 4 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 Wi is (Pavement Cut Regulations.) Signed--4 F APPROVED: DATE APPROVE00nAEkg%eer . ATE V ,'�> J. Supt. of Highways ' t FOR INSPECTOR: Date work started Date completed "-' -SufficienF notification received: Iyes ' no Type of repair: Perm. Temp. Unusual conditions encountered Material slips attached: yes no Dated for Permanent repair Signed - ' } Inspector