HomeMy WebLinkAboutDriveway Street Cut Permits Lot 42 Rimfi BOND
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'tReq. Pr18LiC W0923
Olt,6 DEp
't on File TOWN HALL Date
15U HyAN VENUE
Date of E�cpiration ;
SO
DSOR, CT 0 074 permit No. <.
"PLICA ION F R pL., permit Expires FEE c,Cao �.� `,R+MIT `.
Name and address,of applicant
ocation o
propose wor - I' One No.
escribe
fly nature of A.
permit requested
Insurance on ile wit
Name of Insurer T wn yes no
4' Approximate time ate policy expires .
or completion
b
U. Ca11 before -
a s Xou &9 ticket No. esired at to
Show sketch of proposed work or
furnish 2 copies of s e pa rate ';. .,.
o drawings,
{ o.
4)•
X_
..r r
' OSHA REQUIREMENTS MUST
Ap ,BE FOLLOWS }
plic�nr is res D
.. • ponsibk f .conring the Police
- 1 agree to �r �n�ah to the Town
�P�menc and.CALL BEFORE YOU DIG.
reimburse the Town h of South Windsor the
work in con South Windsor for anns" amount of end
or refinlations f i'sth a Permit and that m r by the Town ft and to.
as outlinW in the Town of South Wind��wave t Cutb ° bOr � files a
nd
tanks
Signed
APPROVED
Supt. o DATE
Highways ".--, 'pR EDt
DATE
FOR INSpE ./� Town ngineer
CT01t.
u uient Date wo#k started
ns0Rs ication re
U-iiusual condition ceived: yes bate co
---1aE countered — — no = iripleted
errar s ipa attached. airs perm.
Y.es` no. aced for _ ertap. -
- - erfianOut repair
Signed