HomeMy WebLinkAboutExcavate to repair broken blowoff Street BOND TOWN OF SOUTH WMSOR 0991
Am It Reg- PUBLIC WORKS DEPAR7htENT.
TOWN HALL Date
't on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH WINDSOR,CT 06074 Permit No.
"PLICATION FOR PERMIT ' =mit Expires
FEE
Name an ddr as f ppli. ant
r
Rhone No. _ ��iS of
Location o propose war-k
riL2fbs ally nature of .p nnit requested
DesipInsurance on file with Town e.s no
ate policy expires
c Name of Insurer
o Approximate time or. compi°etioa
esised star ,ing ' to
Call before you dig ti:�et tJo. -
Show, sketch of proposed work'or. furnish Z copies of separate drawin s
e g
0
IU
9
_.
id
v
n. SFIA REQUT tl MENfiS MUST Bl v PQ.L!T4OW A
Applicant is.teaponslbk for ti��rc sins.,the Police Qeparttnent and CALa.iIEFOk�YOti.iSYG.
1 agree to furnish,•to the Town of ,South-=1-Vtgddor the atnQunt of
reimburse the Tobin of.SvnW�► W deposit .required and to
dspr forham,by + t
work in co nwtion with this Y ' �A�tanance or. repair
per�rtit .and that 1.� 1n with end `ill t�btde b the. rules and
regulations for.p nits as Outlined in the Toatn of $en Y
''s il'aelnant ant liegulitions,)
Signed
APPROVED: DATE APPROVED: BATE/U'Z 'q'�►
Supt�Highways
g Tows` Eiueer
ip
FOR INSPECTOR: Date work started
' u ficient note ication received:. es no Date completed:ple d
Y ype of repair• Perrti. ;.,.. _..,
Unusual_contlitions encountered - ap_ _ .._ _ _ _- --
Material slips attached: yes no Dated for errh"ent repair
'Signed
s Victor •