HomeMy WebLinkAboutWater Street Cut Permits 45 Ridge Road BOND TOWN OF SOUTH WINDSOR N9; _ 7265,
Am't Req.
PUBLIC WORKS DEPARTMENT
TOWN HALL Date' /2 -
Atr 't on File 1540 SULLIVAN AVENUE
Date of Expiration SOUTH WINDSOR, CT 06074 Permit No.
APPLICATION FOR PERMIT Permit Expires
FEE
Name and address of'applicant -
/c'i PS En G .Phone No. 91
Location of proposed work " - R`
Describe fully nature of permit requested:
lnsu 'ice on file with. < own �.....,
Mam,p of Insurer '"' no Date policy expires
.° Appr&irnate time for completion
Call before you di Desired starting date
Y 5 ticket PJo. _9d��//�/D D
aShow sketch of proposed work or furnish 2 copies p s of separate drawin
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QApp kint 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 de
reimburse the Town of South Windsor for any expenses in posit required and to
workJn connection with this � by the Town for maintenance or repair
re&lations for permit and that I am familiar with and will abide b the
permits as outlined in the Town of South Windsor's (Pa "ant Cut rules and
Regulations.)
Signed
APPROVED: DATE
Supt. of Highways `�P7�R,OYED: 14 DATA Z�l
�' . Town Engi eer—
R INSPECTOR: Date work started
Sufficient notification received: yes no Date completed
Unusual conditions encountered TYPe of repair: Perm. Temp.
Material slips attached: no es
Y aced for Permanent repair
x.
Signed
spector