HomeMy WebLinkAboutGas Main Street Cut Permits 360 Diane Dr No 1015
BOND TOWN OF SOUTH VaMSOR
Am't Req. PUBLIC WORKS DEPARI' NT Date
TOWN HALL
It-on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name and addres of applicant { an��d �3c► Phone No
Location of proposed ork Q c. �.
Describe fully nature of permit requested--=,,-_�,-
Insurance on file with Town es no Date policy expires
Name of Insurer Q
0 Approximate time for ctprnpletion , Desired starting date
u Call before you dig ticket No. q L\tf, eL?6 d
Q. Show sketch of proposed work or furnish 2 copies of separate drawings
04
0
0
4.0
o 7—
Q� ~
u
Y
u f
bSHk REQUIREMENTS MUST BE FOLLOWED
a
p' Applicant is responsible for contacting the police Department and CALL BEFORE YOU DIG.
a
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 familiar with and will abide\ by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut iegulations.)
Signed cat ra n rh L
APPROVED: DATE APPROVED: _ DATE �f
Supt. of Highways Town En neer �/
FOR INSPECTOR: Date work started Date completed
u ficient noti ication received: yes noType-of-repair: Perm. Temp.
Unusual conditions encountered
Rv• L Material slips attached: yes no Dated for Permanent repair
Signed
Inspector