HomeMy WebLinkAboutWater Street Cut Permits 43 Jonathan Lan BOND TOWN OF SOUTH WI
Am it Req. NDSOR 6 S4
PUBLIC WORKS DEPAR'TMEIV•L
�. 't on File TOWN HALL Date
1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR. CT 06074 Permit No,
APPLICATION FOR P IT Permit Expires
FEE /O.00 C h K .�k �
Name andaddress of'applicant
L I 1 , / L w (ter o.. ��tc Phone No.
Location f proposed work
G f p
Describe fully nature of permit requested.
ce
Insurance on file with Town yes;; no
0 Name of Insurer Date policy
o --- y expires
0 Approximate time for completion
u
Call before you dig ticket i1o. Desired starting date
a. Show sketch of proposed -
Q, ro osed work or furnish 2 copies of separate drawings
(d
w 21gg
O
.,I
r., i
lk /
a /
v
a�
a I
0
a
Q Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
1 agree to furnish to the Town of South Windsor the amount of
reimburse the Town of South Windsor for an bond or de work in connection with this Y expenses in y Posit required and to
Permit and that I am f rred b the Town for maintenance or repair
regulations for permits as c►utlined in the Town of Souther is and will abide by the rules and
(Pavkment Cut Regulations.)
Signed
APPROVED;
of HighwaysDATE
Suit. --- APPR
---_ ED o n E DATE �!
eer `
FOR INSPECTOR: Date work started'
Sufficient notification received: Date comileted
Unusual conditions encountered yes no
Material sli Type of repair: Perm. Tem
ps attached: _ _ p�
yes no ated for Perrhanent repair.
Signed
Inspector