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HomeMy WebLinkAboutStreet Cut Permits Rockledge Drive BOND TOWN OF SOUTH WMSOR NO. 1011 Arn't Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL Am't on File 1540 SULLIVAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 Hate of Expiration APPLICATIO FyR PER jT Permit Expires FEE --- Name and address of applicant lhe.r. t`c�� Phone No. �- � 3 ©yam Location of proposed work ,.,7 ZIICal Describe fully nature of permit requested Insurance on file with Town yes no Date policy expires [ Name of Insurer o Approximate time for completion Desired starting date v Call before you dig ticket No. Show sketch of proposed work or furnish Z copies of separate drawings a a . lx2/'?, r 0 c 0 0 a X a� a 0 U 0 G M OSHA REQUIREMENTS MUST BE FOLLOWED a n' Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. Q 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 incurred 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: DATE bra Supt. of Highways �G1-7� Town Engineer • FOR INSPECTOR: Date work started Date tom leted pe o Sufficient notification received: yes no yf repair: Perm. Tem Unusual conditions encountered p' Material slips attached: yes no Dated for Permanent repair Signed