HomeMy WebLinkAboutCuldesac Street Cut Permits Ridge Road BOND TOWN OF SOUTH WIN�gp
R
Am it Req. PUBLIC WORKS DEP
't on File TOWN HALL
FrMit
e
1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR,CT 06074 mit No. Qj
"EE ICATION FOR PERMIT Expires
1/V O
Name and address of applicant
Phone No -�
Location Of proposed work
Describe fully nature of permit requested
Insurance on file wit Town
Name of Insurer Ye no ate policy expires
o Approximate time r completion
i Call before --- � Desired starting date
u Y� dig ticket No. _
aSh
ow sketch of proposed work or furnish Z co
ro wj �V 1 J T Pies of s parate drawings
o
b //ar,.
O
X
y
y
w
C
O
V
O
G
td
u
OSHA REQUIREMENTS MUST BE FOLLOWED
a
4 Applicant is responsible for contacting the Police Drpanawnr and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor
reimburse the Town of South W' amount of bond or deposit
work in connection �� this for for any expenses incurred by the Town for required and to
regulations for . Ped it and that I am familiar with and will abide bythemaintenance or repair
Permits as outlined in the Town of South Windsor's (Pavement Y the rules and
ut R pdations.
Signed
APPROVED: DATE
uit. of Highways P VED:
S DATE
Town Engineer
FOR INSPECTOR: Date work started icient noti ication received: Date completed
Unusual conditions encountered - yes AO YPe of repair: Per
ln-
-Material slips attached: yes -----Temp; -
Y no Dated for ermanent repair
Signed
Spector