HomeMy WebLinkAboutSanitary Sewer Street Cut Permits Deming BOND TOWN OF SOUTH VAMSOR zoo
Amlt Req. PUMC WORKS DEPARTMENT Date
TOWN HALL.
,Intt on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR,Cr 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
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Name and address of applicant Z Phone No 2�
Location of prODoed work
Describe fully nature of permit requested - J i1
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Insurance on file wi own yes no Date policy expires e v
Name of Insurer
Approximate time for completionIUf j (45 Desired starting date -
a Call before you dig ticket No.
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Show sketch of proposed work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
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�+ Applicant is responsible foc contacting the Police Department and CALL BEFORE YOU DIG.
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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 with and will abide by the rules and
regulations for permits as outlined in the Town of South 's (Pavement Cut tions.)
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Signe ��i �-"
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APPROVED: _DATE AP OVED: ) DATE Z,,
Supt'�of highways pp Town Engineer
FOR IN,hPECTQR: Date work started Date completed -
Sufficient noti: ication r.eceiveds yes no ype of repair: I3er=n. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent-repair
Signed
Inspector