HomeMy WebLinkAboutConnect sanitary sewer Street Cut Permit BOND TOWN OF SOUTH WINDSOR, NO. MWZX .1011A
Am't Req. PUBLIC WORKS DEPARTbONT Date - ,3 2¢ 9 4--
1
TOWN HALL
Am't on File. IW SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
ate of Expiration Permit Expires
APPLICATION FOR PERMIT
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Name and address of applicant -/M CvFj�,��2 Phone No. 7.5-23 3a�—
o)-7 /Uk,7)DM1ZOO� 421 ELe- /A1,---rQA/
Location of proposed work 3aq NC-yr-;er, /27) S. w//UD
Describe fully nature of permit requested C0/V&)�ec T F/Zdh+ rrA)
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Insurance on file with Town ye no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date 3 9!L
b Call before you dig ticket 11o.
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-a Show sketch of proposed work or furnish Z copies of separate drawings
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y OSHA REQUIREMENTS MUST BE FOLLOWED
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a' Applicant i� responsible for contacting the Police Departrnent and CALL BEFORE YOU DIG.
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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 (Pav a Cut RekbIations.
Signed
APPROVED: DATE APPROVED: /lI� DATE >-Zj
Supt. of Highways Town Engineer
• FOR INSPECTOR: Date work started Date completed
u ficient noti ication received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Iasnector __._�