HomeMy WebLinkAboutSewer Installation Street Cut Permits De A •-
t. s � $t�,, .:xtywf'�F• . _ ,1�. ���i�fi` � +fti�o=.• -S `"„1,'
BOND TOWN OF SOUTH WINDSOR 0957
Am't Req, PUBLIC WORKS DEPARTUM bate
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATI NOR PERMIT
FEE
Name and address of applicant �c�sh$j"' Phone No. 2�
Location of proposed work
Describe fully nature of permit requested
Insurance on file wit own yes
m no ate policy expires ,
c Name of Insurer 8^�
o Approximate tie for completion Desired starting date. _ Z
Call. before you dig ticket rdo.
u
: Showa. , sketch of proposed work or furnish 2 copies of separate drawing's
a �
QQU
x
OSHA. REQUIREMENTS .MU$T HE FOLLOWE>a
Appficant is respom6le for coolacting 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,incurre&by the To" for maintenance ' repair•
work in connection with this permit and that I am 'th "and Will abide by the rules and
regulations for permits as outlined in the Town.of South W' 's Movement,CutRegula
Signed
- APPROVED; DATE AP VED DATE
Supt. of Highways Tows fgineer
FOR INSPECTOR: Date work started
-- . e_completed:
Sufficient 'Ri scation received: yes no Type of-repair:` Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no- Dated for;_ -ermanent repair
$igned
g> ector.