HomeMy WebLinkAboutSanitary Sewer Street Cut Permits Deming (3) ,. ..-c- n:+.�.r+ : nc.:::'-41 s^ . ...t�..ukv"-:�. �;y�n-,.::�k .1'•a�.:<y%� . .,, 7{�A(twyt?'*� .` `='°t�''L'S"$'' � ,� !,.-,:" .c''=atrfi
- :f r o::. `xh Vie- t}rp H."�.,'ts Y'�P: < vai:'�j•,,
BOND TOWN OF SOUTH WINDSORoo
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
it on File. 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSO&CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE /6 ° f=tfi,j
Name and address of applicant Phone No. 4S20 -Jz,, ?
Location:of pro osed work
escribe fully nature of permit requested iTAV
Insurance on ile wi Town yes no ate policy expires
Name of Insurer
oApproximate time for completion Z Desired starting date :I- zZ..gy.
Call before you dig ticket No.
u
o.
Show sketch of proposed work or furnish 2 copies of separate drawings
a
0
y
d
a
u
0
<d
U OSHA REQUIREMENTS MUST BE FOLLOWED
a
�» Applicant is responsible foc contacting the Police Department and CALL BEFORE YOU DIG.
a
I agree to finish 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 f with and will abide by the rules and
regulations for permits as outlined in the Town of South is {pavement Cut��tionsj
Signe
APPROVED: DATE AP OVED: DATE 7
Supt. of Highways PAP . Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Tenzp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair ;
Signed
g Y.
Inspector