HomeMy WebLinkAboutRelocate gas main for proposed box culve BONDTO, YFir
A117't Req. PUH14C wOtiKS
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t on.File TOWN HALL
2 1540 SULLIVAN AVENUE
I#+ermit No.
ate of Expiration SOUTH WINDS08, C1'06074 `
APPLICATIO 'OR PERMIT Fiesn�it Expires
' FEE - '_'— --
Namg and address of applicant - wKF� 2 Gs 1/lc,� P
k hlone_No, •2 y.�.- Z Y
Location o proposed-work
r Describe fully nature of pernnit requested
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l Pr2v POS' . i,
' ow
Insurance on ile with own '
c Name of Insurer Yes no ate policy expires
Approximate time for�cornp tion
4 '
b 3 esir' ,ro .. Call before ydu dig ticket P1o. ed starting 'to
1 t° S}�ow sketch. of proposed work or furnish 2
copies of separate drawings
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.; OSHA REQUIREMENTS MUST BE FOLLOWED I
Appiiant is res
' pt�nsibk for cgntacting the Police De pal and Pa CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the
reimburse the. Tawrt of South Windsor for amoAmt of bond ur deposit
work in eoonaction .with this Y ezpens inrn by Elie Tow n f main Mquired end, t°
regulations for I4rinits as eutWied is the Towne ofam m0#ar with and ebids byPw
Windsor s IPavemeut Cn�"Regv�tiohs•i a
Signed
' APPROVED.
j DATE "
Sup o F ighvrays APPROVED; DATE
To Erigrnder .�
�. FO
I INSPECTOR- Date work started
iciest noti rcation received: Date eonnpleted
yes no ype-of_re
UnVs94l'C0Aditioae' encountered - -_ Pair: Permr; -
Material slips attached: es erne
Y no Dated for ermanent repair
} Signed