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HomeMy WebLinkAboutWater Street Cut Permits 350 Pleasant Va BOND N TOWN OF SOVTH, -WINDSOR 680 Aren't Req. • PUBLIC WORKS DEFAR'I'11�ENT Date K TOWN HALL ,t on File. 1540 SULLIVAN AVENUE Permit.No. SOUTJi WINDSOR, CT 96074 Dade` of Expiration Permit Expires APPLICATION FOR PERMIT FEE $10,00 Tr a AO Name and address of applicant •.aA(rL ,r� �casjSr� to .Z,c Phone No. -203,6 7 Location of proposed work _ r Describe fully nature of permit requested 6 wT o ^, Insurance on file with Town xe no Date policy expires Name of Insurer Approximate tirxl� 4r ,completion ©,q Desired st rt�n date ti g 7-/d �Q y 962 y� - Call before you 1Vo. U Show sketch of proposed work,or furnish 2 copies of separate drawings .'" T / q 14 4-3 { .� 77 aQ, Applicant is responsible for'contactinrthPobce Departnp nt and CALL BEF�RE YOU DIG. I agree to furnish to the Town o 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' (Pavexnen C egulations.) I Signed APPROVED: DATE APPROV D: JI� DATE �7-I�S�I� - ti t. of Highways g y "�j Engineer Su hwa s Town FOR INSPECTOR: Date work started Date completed — ufficiWnt noti .ieation reeeived: yes', no Type-of repair: Perin. Temp. e - Matgrl l= slips-attached_yes..__ nd De,�ted-for Permanent-.repair - -- -- - — Signed Inspector