HomeMy WebLinkAboutReplace damaged sidewalk Street Cut Perm BOND TO NN, f y�' SOU'I' ` � D' R' 095
It Req. PVHLIC WORKS DE�'ARI`MF,N`T'
- TOWN FALL
It on File `1540 SULLIVAN AVENUE ,Permit No.�_ •:',
SOUTH WINDSOR, CI'06,074 ---3
,Date of Expiration
,hermit Expires
APPLIAI N OR E YT --- `
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FEE ;P
Name and address of applicant ` /^ !.
p 1 D COA�„1� '�Qn�No. 70
Location"ot propose work /A
Descrbe. fully n71111alo
r� of permit requested
Insurance on File wit o n yes no ate policy expires
Name. of Insurer
0 Approximate'time for completion es d starttfig to
Call before you dig ticket' No.
.•�, 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 respont"for 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 tindh
E reimburse the Town of South Windsor"for any expenses incurred by the Town for mtintensnce or
work in connection with this permit and that I• am familiar with and will abide bar the rules"
regulations for.. its as ftdined in the Town of South W' s 1>ta t cut Regnlatidr�s:►`
Signed f
APPROVED: ,DATE APPR ED:
Supt. of Highways nC- 4�r�2 ngineer
_ FOR_IN ECTOM ._Date,_work._star_ted ___ - Date, corripleted- -- �z
bu
fficient noti i cation received: yes no Ty of repair: Perm, i
Unusual conditions encountered
Ma}terial-slips attached:-yes no Dated.-forPermanent repair
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`- Signed
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