HomeMy WebLinkAboutDriveway Street Cut Permits 96 Newmarker BOND TOWN OF SOUTH WU4DSOR N2. 1014.
Am't Req. PUBLIC WORKS DEPARTM3M Date
TOWN HALL
Arn't c)n File 1540 SULLIVAN"AVENUE
SOUTH WINDSOR, CT 06074 Permit No. ..
ate of Expiration._ Permit Expires-
APPL
FEE � °FQ►��.�'�R*IT
Name and address of applicant i Phone No.
Location of proposed work '71 ��q j�f ? k•t K i t`y r j �� ? t�
Describe fully nature of permit requested 1. aU L ,AV I
Insurance on file with Town ry 1 —no., ate policy expires z
y
Name of Insurer �`� -
,, p 'l� :, : Desire, starting,date
:_-Call obeftire a tm a for`+� �e-trah ' ". - �
You dig t�cketdo.
ask propose work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
a
D' A lican is reS nsible for c ntacrin Police De n nc nd CALL BEFO YOU DIG.
Q PP E.. ° c_- Q P� R
I agree to furnish tQ the T8wn of South WhMsor the amount of, bona 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 r Regulations.)
ILSigned
APPROVED: DATE APPROVED• - DATE__L4=
Supt. of Highways Tov�rn Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient note ication received: yes no Type of repair: Perm. Tem
Unusual conditions encountered.__-_-_- __ p'
aterial slips attached: yes no Dated for Permanent repair
Signed ,
1jispector