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HomeMy WebLinkAboutWater Street Cut Permits Dart Hill Road ,. ,::; t m r:+,2 .j,:i-z . .,,rw.P.��tia�,:•: s: Rey'-.;!e-ax-- BOND TOWN OF SOUTH WINDSO Ain It Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL Am"t on File 1540 SULLIVAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 D4ate.,of Expiration Permit,.lyxpires APPLICATION FOR PERMIT FEE $10.0.0 Name and address of applicant C-r- Gj©, -} �. 0 O , phone No. 2 y J.,oeation,01 proposed work I r-4 , Describe fully nature of permit requested 1 Y1 r Insurance on file with Town es no ate policy expires' Name of Insurer p Approximate time, •completion°� -- .,.wee.,HG Desired startingdate AT, Call' kefore you did i:icket rdo. a Show sketch of proposed work or furnish 2 copies of separate drawings 0 a. 4J 75. �..4 P4 - :� 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 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 .. �. APPROVED: DATE APPROVED: DATE Supt. of Highways : Town Engineer FOR INSPECTOR.: Date work started Date completed uff csen nszt f=a;tian__r_eceived:__--yes------- no -'Y--- -ype-of repair Perm. Unusual conditions 'encountered Material> slips attached: yes no Dated for Permanent repair ` Signed Y, Inspector a yy iw. f 4 ;3 y • ,': w f' � i, C r,r aF Mr p.. •!.�r3rfo-7,Q � '^�µ .,: h S ' �.0 1,1 t } .r:+ r r Fa x'1 t •a. '�'�Y r 8 f. a,, q1 p, ir� .. ,Ma I al 1 � ,� • x c,.* • J r -,f k°� L^' �,t ,� �+ ° M+ �2 1 4 J '. .�, 4A!'J ! :•. 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