HomeMy WebLinkAboutStorm sewer Street Cut Permits Farnham R BOND TOWN OF SOUTH WINDSOR NO 1033
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m't Req. PUBLIC WORKS DEPAlKa-h ENT Date
TOWN HALL
:z't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration
APPLICATIO F PERMIT Permit Expires
FEE d E
Name and address of applicant P reSE'� Phone No.
Location of proposed work
Describe fully nature of permit requested Insurance on file %xith Town C es no Date policy expires
Name of Insurer
o Approximate time for completion arting dat
Di s Desired ste /te
uCall before you dig ticket 11o. V/rarn,o.,S J#S �--v•2 t) rr
a. Show sketch of proposed work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
c.
CL 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 Windsor's (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVE
DATE
• Supt. of Highways To 'JE 'Weer
FOR INSPECTOR: Date work started Date completed
Sufficient noti ication received: yes no ype of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for ermanent repair
Signed