HomeMy WebLinkAboutTest Holes Street Cut Permits Graham at OND 10 ,O
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Arn't,Req, FU$L_ IC :WORItS DEP.A t T '
e •TOWN HALL
Date-
k+ rnit on File
1540 SULLIVAN AVENUE oxmit No.
"SOUTH.WINDSOR CT 06074
, ate `of Expiration
' hermit E�cpires
APPLICATION R PERMIT
F PER
Name and address of applicant
Phone one No.
r
Location of P:roposed work
Describe fully nature of permit requested
r Insurance onile with Towm es no
ate policy expires 7Name of Insurer /
Approximate time for completion
Call before wired starting to
you dig ticket t1o.
Show,sketch,of proposed work or furnish 2 copies
s of separate,drawings
U.
'^'._,......_._..�i... .__'--. _._•-r-..� ..._ ��J / y may. �►/n/,
» Y OSHA REQUIREMENTS MUS BE FOLLOWED
Appli¢anr is cespO"ie for WAiMing the Police Department and CALL 9EFpRE YQU DlG..
' I agree to furnish to the 'town of South Windsor the amount of 'bond or d reimburse the TO" of South Windsor for sit ez ep4iait required and to 1
':work in connection with thus y Pauses incurad by the `town for rnaintensnw or, reps
permit and that I am mar with and wiE abide by,
regtihations for Wmits as outlined in the Town of South"W ( vett#snt Gist nn�_y�Y_t� anti
! 't •s Psk �uhath000- f
1
Signed
APPROVED. _DATE
APPROVED: DATE �� `�-J4-
Supt.oTHighways
To.wm Engineer :
r,. F`OR.INSPECTOR: Date work started '
u ioent note tcation received: es Date completed
y no 7 e of re ir: Petcm. ---�- ,
. Unusual .condtt Ong.encountered p
Material slips attached: yes no Dated for errrtanent rep$ir. ,
Signed
s .octor