HomeMy WebLinkAboutGas Service Street Cut Permits 760 Pleas -... s.. .p..`.'f.�...t y „ '•.�.�'�'f.�'y- .t�6i"a : Ri. .. ,y�y . .+F'.s•R' _ .'-_"—..-`�__A_
BOND TOWN OF SOUTH VAMSOR
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It Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
on File 1540 SULLIVAN AVENUE Permit No.Zj4-9_z
SOUTH WIND60R,CT 06074
Date of Expiration Permit Expires
APPLICATION rFOR PERMIT
Name and address of applicant_; �� �,�„ �.e, .� o C ti o__ Phone No, 2-CA Z-Z Z-L►5_
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Lkication of proposed work
Describe fully nature of permit requested --'
hsµrance on file with Town e n ate policy expires
a ame of Insqrer
a Approximatei 'e ��or pletion f Desired starting date_j _ 1-7.-q 4
Call before you dig t:.i.c C7o. .
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;Show sketch of proposed work or furnish 2 copies of separate drawings
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'« OSHA REQUIREMENTS MUST BE FOLLOWED P15t "G
Q AAPlitanr iarresponsibk for contacting the Police Depanmenc and CALL BEFORE YOU tild.
I agree to„furmsh to the Town of South Windsor the amount of bond or deposit required and to
reimburse tiie Town of South Windsor for any expenses incurred by the Town for maintenance or.repair
work In 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: 34� ;. .DATE /G��y-�3'�
Sept.of iglu hways Iowa •.ngneer
FOR g!5PECTOR: Dafe vmzr s ted Ditto completed
_u iciest noti_ication receive V-e _,___.no e of y epa r.'Perm �enn�►""" �"`- _
Unusual ;conditions encountered
Material: slips attached:. yes no Dated for Permanent"repair -
Signed
epector' _