HomeMy WebLinkAboutGas Service Street Cut Permits 360 Pleas (2) p rti',:�t¢ •fi.. ...�A4 • e c' r ^3�;` -
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TOWN HAIL ' r
1r It on �`i1,E ;,. 1540`SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
�15ate 6f�Expiration Permit Expi s
APPLICATION FOR PERMIT ' "
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Name and address of applicant 1�.�d/y 1� f` G HS Phone No. , 6,7 /:2
Location of proposed work V1f Z-
Describe fully nature of permit requested:
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Insurance on file with Town yes no Date policy expires
Name of insurer
oApproximate time for completion Desired starting ate
Call before you dig ticket Poo.
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Show sketch of proposed work or furnish 2 copies of separate drawings
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} Q Applicant is responsible for contacting the Police Department and GALL 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 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 lfor permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
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Signed
APPROVED: DATE APPROy.-9D: CZL, � DATE
Supt. of Highways To Engineer
FOR fft- PECTOR: Date work started Date completed' '
Sufficient noti cation received: __yes ho Type of repair: Perm Tamp,
Unusual conditions encountered .,
Material slips attached: yes no Dated for Permanent repair
Signed
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