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HomeMy WebLinkAboutRelocate water main Street Cut Permits F TOWN OF SOUTH WINDSOR �� - 791 BOND - It Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL m't on File 1540 SUL11VAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 Date of Expiration Permit Expires APPLICATION FQR PERMIT FEE Name and address of applicant 00pPhone No. 111 F Location of proposed work Describe fully nature of permit requested. -e L c,, r� alb � tnaa1PI rcA,w,aaf- cT Insurance on file with Town yes, no Date policy expires Name of Insurer oApproximate time for completion o—<7 Desired starting date d Call before you dig ticket ido. G 1 'Z.'I 25-© U Q. Show sketch of proposed work or furnish 2 copies of separate drawings Cd 04 I OC r. ID t a �L } 4, a� 1'E�rt -I?- o U 1r Cd w t�� QApplicant 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 Windsor's (Pavement Cut Regulations.) Signed x 1 1 r7 APPROVED: DATE APPROVED--�._ i�-� � p ATE f' ' Supt. of Highways Town tnil „ ,er j FOR INSPECTOR: Date work started 'Date completed Sufficient notification received: yes no Type of repair: Perm. Temp. Unusual conditions encountered Material slips attached: yes no Dated for Permanent repair Signed Inspector