HomeMy WebLinkAboutGas Street Cut Permits 521 Quarry Brook - - soN TOWN OF SOUTH WINDSOR N Q 803
Am't Req.— PUBLIC WORKS DEPARTMENT
TOWN HALL FDate
m't on File 1540 SUUI AN VENUE
Date of Expiration
SOUTH WINDSOR, CT 06074 o.
APPLICATION OR PERMIT Permit Expires
FEE
Name and address of applicant \ZA4A ._ _ C-,>4
Phone No.
Location of proposed work _`_:A f tJ.9e2iZ r GC,
its e, /vr-37
Describe fully nature of permit requested. ?�rT,d e4 �A
� ., .SE•,z✓y cam-
Insurance on file with Town
Name of Insurer �� riO Date policy expires / /4-
0 Approximate time for completion , y Desired starting ,
u Call before you dig ticket i1o. ate L
4 Show sketch of proposed work or furnish 2 copies of separate dra
tv
wings
s
o44
S Z�
it
Au a
i^
4
u
QApplicant 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:
Supt. of Highways
P7-4 Town Engineer
\ FOR INSPECTOR: Date work started
Sufficient notification received: yes no T Dane completed
Unusual conditions encountered ype of repair: Perm. Temp.
Material slips attached: yes no Dated for Permanent repair
Signed
Spector