HomeMy WebLinkAboutTie sump pump discharge into Storm sewer $OND
-�- 'OWN OF SOI1T 0993
An It Req. PUMC WORKS DEPA►RI NT
TOWN HALL
t on File
Date
,77
1540$ULIIVAN (►VENUE - Permit No.
Da a of E SOUTH WINDSOR,CT 06074
Expiration E
erinit Expires
APPE ICATIOI}T4 fO PIR MIT --
5 u s fr
Name and ad ress of appli
a No,
Location o prop a wor t 0 "
t
t` escri a fullyature of permit r quested ,
Insurance on file with Town es no ate olic e
Name of Insurer P y xpire's
o Approximate time or completion
" Call u 4 esired starting' to /t3
ro before you dig ticket No. _� �a
u -}-s-
4 Show.sketch of proposed work or furnish 2 co ies of s partite drwin `s
y g
q
rc
�a _
X C Q0 C),
iA
e
V
- OSHA REQUIREMENTS MUST BE FOLLOWED
Applicant is respoccsidle for contacting the Police D�epanmenc and CALL BEFORE YOU DIG.
4.
I agree to furnish to the Town of South Windsor the amount of bond or_de reimburse the Torn of South Windsor. for an ez Pit. m9ud and to
work in,.connection with thus y Pew inaw1 by the Torn for maintenance or
regulations for permits as outlined i t and that I am famil tie with and '
the Town of South Windw s IPa abide by the niles.a'
,, a tioas.l
Signed
A�:P P RO VED: ..,
, 3 DATE APPROVED:
Supt.o�ighways ATE �l
T a er
FOR INSPECTOR: Date work.,started
Date completed
U'l
u ficient note ication' received: es no .� -
Unusual couch ions encountered
Type of repair. Perrin. Temp.- - -- --
-- II te.ral slips attached: yes no Dated for ermanent repair.