HomeMy WebLinkAboutWater Street Cut Permits 507 Graham Road N_ 734
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:_ Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
rnIt on.File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICAT ON FOR PERMIT
FEE •a r/
Name and address of applicant Q L Phone No.
Location of proposed work
Descr'be fully nature of permit requested. _ on
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Insurance on file with Town yes 02a. Date policy expires
Name-of Insurer
oApproximate time for completion ne Desired starting date
Call before you dig ticket No.
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Show sketch of prgposed work or fur 'sh 2 copies of �paTte dra.wi*gs
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Applitant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I I -agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reit iburse 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 nd will abide by the les ands-
regulations for permits as outlined in the Town of South Windsor's avement Cut Regular` ns.►
Signed
APPROVED. DATE APPROV LOD:--� j,� ATE /
Supt. of Highways iL- o Town Engineer
FO>t INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair »
Signed.