HomeMy WebLinkAboutSanitary Sewer Street Cut Permits 343 De ..A'?Zv. q rs.y.,-v+r x pf'}'!'{'.r r•r.:�':.-.t•r sra'rnag r'�r:�'�3'rx"-ct� � �,� � ." .�Z, �+-'�eM�`�€i_'�";�..yet,
iC?ND 'Q W. N OF SQCMH WINDSOR.
Ut Req. TUBLIC WORKS'DEPARTMENT Date .
TOWN HAU ,
It on kile*. 1-540_.SULLIVAN AVENUE Permit'No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATIO OR PERMIT `.
FEE $16.00
r ` -
Narne and address of applicant ;A-MtL C)OST' Phone No
Lck
ocatian of proposed work 1
Pescribe fully nature of permit 'requested.i � �.. j 1" i:ft►rt lT u
r} Insurance on file with Town h no Date policy expires 19Y,-`jo
Name of Insurer
1�
Approximate tirneQr eompl.etion _Desired strt }g date IJ- ":eq
_.
s Gall before you dig �f iaket Tdo. Z 1 it
k a Show sketch of proposed work or furnish 2 copies of separate drawings
� p
C, ).
y
i
Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor `the anmount` 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 petmit and that I am f with and will abide by the ruses arid_
regulations for :permits as outlined in the Town of South V dsor's (Pavement Cut Re la ions.)
.,
i
P Signed` _
APROVED: DATE XP{�ROVED: DATE /0
: .
Supf. bMigh�vsiys Town Engineer
' R TNSPEOTOR: Date work'sta.rted Date completed
ufic '®rit notification-received€ des -- no r ype of repair: Perin: �'emis
Unwsual co,0ditions encountered
Material=slips attached "yes rio '15acted for Permanent repair
-
/' Y s8ct4�x
-