HomeMy WebLinkAboutConduit Street Cut Permits 713 Foster St . IoND 'OW N O SQL � �►IJR � 0 �
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Arn't Req. PUBLIC WORMS DEF
' TOWN HALL }Date
't on File UE
1540 SULLIVAN AVEN Permit, No.
SOUTH WINDSOR.Cr 0056A —"-=
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'Date of Expiration Permit Expires
� APPLICAI F I� PERMIT
x FEE f<J
Name and address of applicant ,�v�hoae�To.
Location o propose work-W , . �, s✓- �C F
k esribe ally nature of permit requested ��, �, �,,YQ �
' Insurance on file with own es no ate policy expires ,��t-, k� s
Name of Insurer �/ti .. .
i M AP.Proximate time for completion / ,4. esired atartiing to . 78
Call before yott dig ticket tJo. 9 3 '
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aad Show sketch of proposed work.or furnish 2 copies of sepa;ate drawings
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OSHA REQUIRE14ENTS MUST BE FOLLOWED
t Applicant is responsible for conacting the Police Department and CALL.BEFORE YOU DIG. j_; ,."f:
I agree to furnish to the Town of South Windsor the amount of bond or deposit mguhtd` #nd to_
Mmbutse the Torn of South Windsor for.any Expenses incurred by the Town°for mainteirance or. 's
work in connection with this 4 `t permit and that: I am`fam�isr wi and; pill.••%abide-.by. the
regulations for parlhits as outlined in the Town of 6ou Win is's Paw t Ca
t'Rogula 'o .) , ,.• ,
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Signed
APPROVED: , DATE APPROVED: DATE ? s.
Supt. o Highways f.
N t f
f / Town ngiteer
FOR IN$PEC`TOA: Date.work_started matt .cormplet�ed.� x u `f efent note rtion received: es no --
ype bf repairs' Perm. einp.
Unusual conditions encountered;
Material slips-attached: yes no Dite-d for pEirmarient re i : - - _-
Signed