HomeMy WebLinkAboutDriveway Street Cut Permits Lot 51 Pheas . DOM) TOWN OF SOIJT MIN SOR 0 .
Am+t=Re h't MC WORKS DEPAI ILNT
9 '?ate
TOWN HALL ,
It';on Fila 1540 SULI,IVAN AVENUE Permit No.
SOUTH WINDSOR. CT 00074 ;
Oate.of Expiration
Permit Expires__
APPE ICAYION FOR: ERMIT
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Name and address of a licant f
PP _����� �,� Jl�rr Phone No.
Location o proposed work 1
Describe fully nature of permit requested ,max
Insurance on, tile.wit Town a no ate policy expires -
c N irne of Insurer }, r. .�...
A Desired startiog . to w ,:
o Approximate time f r ,comnp a ion -
A
4 Call,before you dig ticket 14o.
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a Show sketch,of proposed work or furnish 2 copies of separate drawings
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0
y
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4• OSHA REQUIREMENTS MUST BE FOLLOWED
Applicant i* responsibk for contacting the Police Deparnnent and CALL BEFORE YOU DIG.
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 Tovrn for maintenance"or, repair
work in connection with this permit and that I am familiar with and WM abide" by the .rules and,
rejgulations for permits as outlined in the Town of South Windsor's IPave t Cut=Regulations.)
Signed
APPROVED: DATE APPR' LD:
f
Supt.oHighways P To 'egineer
'OIt INSPECTOR: Dane work started __
Date completed
' ri._recei_�ced:--�►eS-- - ao-_._"_ __ ype of kepais:--1?e - p - ---
"Unusual conditions,encountered
Material 6lip4_Attached: yes no ated or ermanent repair
i - Signed
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