HomeMy WebLinkAboutWater Street Cut Permits 761 Pleasant Va � .." .:.,G.+.iSR+• 3 a•nr- i"�'�• ��,a�i@�Mi 5TM`-'sue �c •'�ir^+� 77
, '-i.lUv'!`'Ty54�'r"' .,nC_,.g':.,
tk
42�
087
. . DOND TOWN OF SOUT14 WINDSOR
it Req. '` PUBLIC WORKS. DARTMENT Date
_ TOWN HALL
It on=File 1540 SULLIVAN AVENUE Permit. No.
SOUTH WINDSOR, CT 06074
Date -of Expiaration.; Permit'E" xpires
APPLICATION FOR PERMIT
FEE $10.00
Name and addre s of pplicant h Phone No. f 7cJ
me e t " v� lt1i sore,T o4 o 4:
Location of,.proposed work
.Describe fully nature of permit requested_
Insurance on file with Town es no Date policy expires
Name of Insurer
Approximate time fob completion esired starting date G
Ca1T before you el met'140-
+= Show sketch of proposed work or furnish 2 copies of separate drawings
a
0, 7Ile
O
r !
� J
Q.
� a "
Applicant is responsible for contacting the Police Department 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 in 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's (Pavement Cut Regulations,)
Signed
APPROVED: DATE APPROVED: 71
DATE .. /
Sipt f ig ',ways Town Engineer
,:. FOR:INSPECTOR: Date work started Date completed
F = ufficient notification--received: -- yes no Type of•repair: Perm: Temp:
_Material sl p.s 'attached:.,yes no. Dated..for Permanent repair -- _
d
Signe