HomeMy WebLinkAboutRepair water main Street Cut Permits Int BOND TOWN OF SOUTH .WIMSOR 0929
Arn't Req. PUBLIC WORKS DE %RTh0W Date
TOWN HALL
't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR,CT 06074
Date of Expiration Permit.Expires
APPLICATI OR PERMIT
FEE _
Name _ajid ddress f appli ant Co. Phone No. ,55*4
Location of proposed wor
Describe fully nature of permit requested
Insurance on file with Town yes no Date policy ,expires
Name of Insurer
oApproximate time for completion Desired starting date ...
Call before you dig ticket r1o.
u
o.
Show sketch of proposed work or furnish 2 copies of sepaarate drawings
o
y 476�e-r naC
100
OSHA REQUIREMENTS MUST BE FOL .M- 1)
o,
l►pplicant is responsible for contacting the Police Department and CALL BEFORE YOU.DIG.
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 WindSWs ipavMent Cut;:Regulations.)
Signed
APPROVED: DATE APPROVE I� DAE
Supt. of Highways T
Town Eft eer
FOR INSPECTOR: Date work started Date completed
u ficient noti >Lcation received: es _ no T ypt_of repair: Perrin. Temp.
Unusual conditions encountered
y-
Material.`slips attached: yes no Dated forPerm-anent repair
Signed *}
{ =ep CARZ