HomeMy WebLinkAboutInstall telemetering and pressure sensin BOND TOWN OF SOUTH Wmsm
Amtt Req. PUBLIC WORKS DEPARTAEMNT Date
It on File - - - TOWN HALL
1540 SULLIVAN AVENUE Permit No. 2,al
SOUTH WINDSOR,CT 06074
Date of Expiration Permit Expires
"PLICATION - OR PERMIT
FEE
Name and address of applicant Y�
.4l ter-- 6,.$Y Phone No. szlgz 3
Location of proposed work 4&g62ZZ21
Describe fully nature of permit requested
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Insurance on file with Town es no ate policy expires y..i-ys-
t: Name of Insurer ��
o Approximate time for completion ? 41+Ai Desired starting date �►.» 7--r Y
Call before you dig ticket Pdo. _9�•..3`2 1_3 71
Show sketch of proposed work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
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Q Applicant is responsible for contacting the Police Depasanent 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,)
01
Signedi
APPROVED: DATE APPROVED: f DATE
Supt. of Highways L;f.7`' Town Engineer
FOR INSPECTOR: Date work started
Date completed
Sufficient noti ication received: yes no Typeof repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
- Signed
spector