HomeMy WebLinkAboutRepair broken water main Street Cut Perm (8)p •ter .. Y�r 1 '�r, P...'.Rltli1FIDB°�@�'sY�TIi(q� p T« � _ �'Y
OND . 0 NQZJ"Z' 171
Am't Req. PUBLIC W(?M
TOWN HALL. _ ;
't on File 1;40 SULL[VAN.!.VENUE Permit`No. "
SOUTH WINDSOR,CT 06074
Date of Expiration
Ir�'ermit EapiresT
APPLICATION PEIZMff
FEE
P z ,
Narne aino address of applicant �, 7 Phone No,
ocation o propose . work t
escribe fully nature of permit requested
Ir%surance on ile with T_own es.1' no ate policy expires
e Name of Insurer - 1
�c Approximate time for.tom etion pesised start og` Le _ PA *,
Call before you tq ticket t1o. •
Show sketch of proposed work or. furnish 2 "copies of sepla te dr4-0
awings #"
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SI3A REQUIREMZaNTs"MUST BE FOLLOWED j.
Applicant is responsible for contacting the Police.Depantnent and CALL BEFORE YOU DIG.
" I, agree to fa h to the Toivn of South.Windsor the amount of bond or deposit. required and
reimburse ahe Town of South Windsor for any ezpenses incurred.by the TO" for main, naum or
work in connection with this permit and that I am �diar with and, eNl abide by rules
reRulalions for permits as �►uttined in ties Too►n of bons:
SignedAll
s APPROVED: DATE APPROVED:, ATE -^•, � ,
Supt. of Hg ways Town n'sneer
FOR INSPECTOR: .Date. work started 1 Date co p ,feted
- __
u icieri►t riots ><cation received: yes no ype of repair: Perm. Temp.,
Unusual conditions encountered
�-Material slips-attached:-yes no__ Dated1orPermanent- repair -
Signed
sHctor