HomeMy WebLinkAboutWater Street Cut Permits 238 Graham Road - BOND TOWIN OF SOUTH WINDSOR
It Req. PUBLIC WORKS DIEPARTkOWDate
TOWN HALL:
It on Fill 1540 SULLIVAN AVENUE
SOUTH WINIXOR,CT 06074 Permit No. f�
-Date of Expiration SOUTH
F( R PERMIT -Permit Expires
FEE
Name and address of applicant
S� ZATone No7 �
Location of ropose work
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Describe fully nature of permit requested
insurance on file wit own yes no ate policy expires
c Name of Insurer
o Approximate time or completion Desired at date
Call before you clig ticket Y1o. .-
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a. Show sketch of proposed work or furnish Z copies of separate drawings
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a• car j�j ���� �_/
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OSHA REQUIREMENTS MUST BE FOLLOWED
a
Q Applicant is responsible for contacting the Police Department 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 T6wn for main
work in connection with this permit and that I am familiar with and will abidethece or repair
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut es Rby egnlati o . andns.)
Signed _Art4 4
APPROVED: DATE APPROV , • DATE /d 9 _
Su t.of Highways
p �L-V To`an ngineei
FOR INSPECTOR: Date work started D
Sufficient noti tcation received: es no ate completed
Y ype of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated—fo-r-P erManent repair
Signed
Inspector