HomeMy WebLinkAboutDriveway Street Cut Permits Newmarker Ro 7 7"
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wit`Req, PUHI C WORKS DEP
t TOWN HALL 'Late t
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P[emit No. ;
Date of Expiration SOUTH WINDSOR•CT 74
AP 'LICATI -_ ,p Expires ,
F E �
R IT
Name and atddress'i�(' Bpp�icant T
ONO* v2/
ocation of propose work �,
' Describe fully nature
p rmit requested
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Insurance on file wit o n
y no ate policy expir s
c Name of Insurer a ,�,
t,. Approximate time for co pletion Desired start}n to
�-. Cali before you dig ticket P1o.
r
Show sketch: of proposed work or furnish Z topics 'of a drawings
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s}f
O 1 !2 d t 'i
/ A v d l`
OSHA REQUIREMENTS MUST BE FOLLOWED
Applicant is responsible For contacting dw polite Mpamnenr and CALL BEFORE YOU DIG. ` t
I agree to, furnish to the Town 6f South Windsor the amount of bond ;w deposit required 012tl to reimburse the Town of South Windsor for an ez
y pew hwum d by ti;%
for main
work in connection with thus tenance or air
regulations for pit and that I am liar with abide by the rules a .
penhits as ou Town of
teed in the South 1Nindeoir's IPav$ttent Cut bona:j
Signe.,�
APPROVED: DATE APPRED: DATE'
Sup ghways Town ngineer
`0 FOR INSPECTOR,. Date work started
Date completed .
-- -- u frciertt. z o tcatiop received: es no , -
- y ype of repair:, Perin':' e *
ususi comditions-encored
Material slips attached:_ yes. no Datedfor ert'nanent repair. - ---
Signed
F . Jfi
Spector