HomeMy WebLinkAboutWater Street Cut Permits 54 Oak Street BOND TOWN OF SOUTH WINDSOR
ArnIt Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.;p b e
SOUTH WINMR,CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEEName and address_ of applicant '^�t _ ,� N,.x y/>�� phone No 1v
Location of proposed work Q
Describe fully nature of permit requested7-
Insurance on file with Town yes no Date policy expires
Name of Insurer Y
Approximate time for completion Desired starting date L.) , / / t
Call before you dig tidcet No. C
J l-
a.
Show sketch of proposed work or furnish Z copies of separate drawings
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e
0 5 `(
0
o°• Q ,
Dr4�ST
a
0
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OSHA REQUIREMENTS MUST BE FOLLOWED
a
Q. Applicant is responsible for contacting the Police Depantnent and CALL BEFORE YOU DIG.
4
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 APPROVED:d ,DATE A-/7-71
Supt. of Highways T En i er
FOR INSPECTOR: Date work started Date o c mpleted
Sufficient notification received: ___yes no _y a of repair: Perm. Temp,
Unusual conditions encountered --- —
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector