HomeMy WebLinkAboutPump foundation water into culvert Stree $OND TO 'QF SOU vv NnsoR. 691.4 .
t Req.r''' PVBY.IC.WQ�tKS DEPAW �MT
TOWN HALL ;
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Cpqn File 1540 $ULLIVAN AVENUE Pe it 110. .
SOUTH WINDSOR,CT M074 ;
of Expiration `
Fesmit Expir
g APPLICATI �N ( R PE IT
FEE
Name and address of applicant
Phone No..
Location of proposed work 02 3 n,%T
` Describe fully nature of permit requested ?"a uMj Tow
Insurance on file with Town yes no Date policy expires
Name of Insurer
o Approximate time for completion Desired startingdaite
.,;
Call before you dig ticket 11o. .
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Show sketch of proposed work or furnish 2 copies of separate drawings
O f.. -
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it o
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OSHA REQUIREMENTS MUST BE, FOLLO"D
Applicant is responsible for concaeting the Pal ce'Depanment and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or deposit raquit and to
rei tburse the Town of South Windsor for any ezpenseb incurred by the Town for maintonizW or `repair'
work in connection with this permit and that I am fa"Iw with and will abide by the Rules attd'
regulation"s for permits as �artlinad in 'the Town of South 'Windsor's Waven at-Cut Re�ui tiac.>hs ►`
Signed - z
�APPROV Ia: DATEr PROVED: . DATE '
Supt.ofHigbways Town Enjineei—
-fop'--INS CTOR: Date work started - Dat:e co�ii�pheted : -
-Sufficien ion• :� e_s-- noe-o repi -Pew.--- np -- ,
Unusual conditions encountered
-Material slips attached: yes no ated for ermanant repair
Signed
apector