HomeMy WebLinkAbout6 laterals for 2 lots Street Cut Permits r ■j.�■,RT'
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�t OQ .PiIE 1540 *T*Q*W* AN-
Iy HM�J.EN* t e r
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hate of'Expiration SOUTH �NDSOR, CT 06074 ,ermit 1�To.
APPLICATON O EMIT geimt Expires t
FEE J I� . _ ��Q ,
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Name and address Of applicant
., S Phone NO
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r ' ocation o propose work
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escribe oily nature of permit requested
Insurance on wit Town y no K
Name of Insurer ate policy expires
. Approximate tune for completion'
rt T Desired starting to
b Call before you dig ticket No.:.�
.34
Show sketch:of proposed work or: furnish 2 co i �
ro P es of separate dra
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Q Nri) at 35 r g
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b,, A�- r
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AT
Will
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OSHA RE4UIREMENTS MUST BE FOLLOWED +
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r4. Applicant is cespm"k for concxcin dtie P °
8 oUce�Wnmenr and CALL BEFORE YOU DIG. • �`
I agree to furnish to the Town of South Windsor the amount of bond or
reimburse the Town of South W'
work`in co mdsor for any ezpensea incurred y the Town .t required ash'
gulatioas for perbu'ts aa'th�s Pit and that I' am UlMiVar with
or s°
re
in the Town of South- Wiridsors`
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. ; Signed
APPROVED: y
DATE APPROy , !
Supt. of Highways
To Eng eer - f,
FOR
INSPECTOR:' Date work started T
ft
ficient note ication received: Date torrmpleted
_ no ..
-- -Unusual conditiO�ii yes s,encountered _ Yee-of re ► irs" Perm:
sips attached: yes no
red for ertnapent re l _ p
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Signed:
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