HomeMy WebLinkAboutDriveway Street Cut Permits Lot 50 Pheas •
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BOND 'OWN raOF ti �iVI �� 9
�7 ,80- ft
Am't Req. PUBUC WORKS DLPAR7.M9NT Date
t TOWN HALL J.
L 't on File 1*SULLIVAN AVENUE' -
Permit Nb.
' SOUTH.WINDSOR, Cr 06074
ate of.Expiration P!ernsit Expires '
AFFLIC TION FOR P�RMIT
F>9E L4.e~�tJ Chi i, g
JMJ Construction Co. " ;Name and address of applicant Ph, eN S2 062$
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Location o propose worlq,Qtp PheasantWad
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cribe ally nature of permit requested Cu ur o.
Insurance on ile.with own yes' no ate policy expires
Name of Insurer r-*--�
o Approximate time for. completion Desired start,ng to�
Call before you dig ticket tio.
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Shove sketch: of proposed work or furnish 2 copies of separate drawings
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o OSHA 1tEQUTREMENTS MUST BE FOLLOWED
Applicant is responsible for contacting drc Police Qepanmenc and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or depQ3it required and to"
reimburse the Toga of South Windsor for any expenses incurred by the Town for meintenanee or. rear
' work in connection with this permit and that I am fam0 ar with and will,ebulel>>by. the ,rules ate'
` regulations for permits as outlined in the Town of South Windsor's (Pavement;Ctit Reguh ti+onsa;
Signe''
E APFROV ED: DA,T..E APPRO. D -__�/ DATE
Supt. of Highways Pero Town . ngiaeer
"FOR INSPECTOR. Date work started Date _q .lete
_ � f�cient noti cation received: yes no- ,. .P-erm.�_
Unusual conditions encountered
Material slips-atrae'lte-d: 'yes -fib Dated for: a manan-r ptir
Signed