Loading...
HomeMy WebLinkAboutWater lateral Street Cut Permits Lot 10 BOND TOWN OF SOUTH WI" OR N.Y - - 546 Am't Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL It on File 1540 SULLIVAN AVENUE Permit No. Date of Expiration SOUTH WINDSOR, CT 06074 APPLICATIO F9 PERMIT permit Expires FEE Name and address /olf applicant '��, (_, � � �h� Phone No. C )5 `7- Location of proposed work cct Describe fully nature of permit requested C Insurance on file with Town _._yes no Date policy expires c Name of Insurer o Approximate time for completion Desired starting S date , z u Call before you dig ticket P1o. 902 / 9c, f B4 i 0a Show sketch of proposed work or furnish 2 copies of separate drawings . o o I _ 0 1 l i C; a� a� I a O 0 id tJ. W 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 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 W` dsor's (Pa ement Cut Regulations.) Signed APPROVED: DATE APPRQV D: DATE Supt. of Highways T E eer - ' L� FOR INSPECTOR: Date work started Date cornpleted Sufficient notification received: yes no Type of repair: Perm. Temp. Unusual conditions encountered Material slips attached: yes no atyK fox- -errilanent repair Signed Inspector'-. TOWN OF SOUTH WIN©SOR DEPARTMENT OF PUBLIC WORKS • BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT NO 5776 19 - .- Pursuant to written application, permission is hereby granted to the Licensed Drain_ Layer named herein to perform the work indicated below at at premisesowned by whose address is r i;r r 1,, 1 ;1 ? . ( < ,,,, and to Lay House Drain, _ ,_ Repair House Drain, Lay Main, Other , for i occupancy or use, with Family Units , with / acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with Show sketch of proposed work or furnish two (2) copies of separate drawings . SPECIAL CONDITIONS Desired Starting Date _ Estimated Time for Completion �- • Permit to be issued to 1 1 i r the holder of Drain Layer ' s License No . t ( ). Permit will expire thirty (30) days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth in the permit and the reverse side thereof. Applicant has received Town Permit No . and/or CHD Permit No . . 4 (•1 Signed _ i �ii License&; Drain Layer The above named Drain Layer has a valid license issued by the State of Connecticut and has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor : _-ji' •' Engineering Dept. Date ,7 _ Permit Fee Paid $ Check .Number Connection Charge Receipt No. '!�` l Dated Issued b , 7'; i �f y ;�'1 F 3 , I INSPECTION Date work started Date completed Sufficient notification received : Yes No ecial Conditions APPROVED: Inspector Date