HomeMy WebLinkAboutDriveway Street Cut Permits Lot 38 Jared BOND " TOW ' . Of `SO�1T
;Axh t Req. PUBLIC WO tKS DEI� tT�1EN r i
TOWN HALL Date �.-
't;on .File 1Y40 U VAN AVENUE
S Kermit No.
T, I
SOUTH WINDSOR, cr o6o74 _ --
a `Date of Expiration ! a :`
¢ermit Expires ;
APPE ICA �W APE IT ---�- -
TF
h r • _� - . .. •-. .. .. 1.
Name and address of applicant /J �n Sy�� i-,Phone No. �2-
Location of proposed work
5
Describe fully nature of permit requested C
Insurance on file wi h Tgwn a no ate policy expires
Name of Insurer d
s g' -
o Approximate time for completion Desired starting to �► '
;�• Call before you dig ticket 110. Q
Show sketch,of proposed work or furnish 2 cop s of sep ate drawin
`4 = g
of
` OSHA' REQUTREMENTS MUST BE. FOLLOWED
Applicant is responsibk 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 depit required end cfi {
reimburse the Town of South Windsor, for any expenew incurred by the Town for maintsuanep,•or .
work in connection with this permit and that I am famo ar with and wiU abide `by tl e i ile ' aid
!r
} : • regulations for poinits as outlined in. the Town of South Vllindsor's (Pavement Cut 1*dwiia� s:)
e
Signed
APPRO'VED: DATE APPROVED:, , DATE r
Supt. of Highways — „ Td"wn E gineer
'FOR INSPECTOR: Date work started
E __. Date completed,T= y_
u ficien eceived: y __ W.¢-off g
Unusual conditions encountered
Material slips attached: -- - ---p -yes no Dated for ermanent repair
Signed