HomeMy WebLinkAboutCAble Street Cut Permits 77 Gail Lane aaorrD 'Q�V1Y Q S W
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9•, PUBLIC �VOIIKS".IMF
't on Fil' MOV HALL. Late
1540 SULI3V,AN fi VENUE '
E SO Fei�mit No.
late of zpration SOUTH W111DSOR CT o6074
APPLICATIO F Permit Expires
MW
FEE j `pEIT -�-,
Name,and address of applicant
Location 'of propose wor
lk
escribe fully nature of permit requested - T
of
In urance on ile with own p -
Name of Insurer n° ate policy expire
Q Approximate time for completion x
Call before yptl dig ticket Pao, esire starting` Le
a. Show sketch:of proposed work or furnish 2 copies of se a lot = '
P i' a dra
n"
wings.. .
`I.i
Idr s
OSHA REQUIREMENTS MUST BE FOLLOWED
. .i�. APPiicanc is msponsibk for contacting the Police Depucaunt and CALL BEFORE YOU DIG. `r•
1 agree to furnish to the Town of South Windsor the amount of bond or 't
reimburse the Torn of South W' deposit required and to.
work in conneetion with this permit and any expenses m by,the Tq«n �, mantenan;e
regulations for that I am mar with and °i 1*09
polnite as audined .in ;wall abide by the rules and
the Town of South Windsor's 1Pavenent put Regulatibns.�
Signe ,
APPROVED: DATE
APPROVED `
Supt. o ighw y DATE
ineer
FOR INSPECTOR: Date work started _
u icient note ication received. '— Date erornpeted
f ,
' yes a of re r
Unusual conditious encountered " repair: Peron• Tefrr� - T ,
"Material slips attached. es no Y ated for Permanent repair
- Signed
ector > ,.