HomeMy WebLinkAboutRepair broken water main Street Cut Perm (14) ..,, �.. w-•• �-`-Y't7W� �.���ti�+ - .�;.r, .�'"�.p, .,'b. �C ��,,"�i`�$t,7'a'�r+� i ".,3s,...., ,`at ...
$OND TOWN OF jj ,�0
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PUBUC WORK$ DEPARTMENT Oats
TOWN`HALL "'_----- -----
't on File • ;1540 SULLIVAN (,VENUE Permit No.
SOUTH WINDSOR, CT 06074
-::Rate of Expiration
Permit Expires
APPLICATION OR PR.MIT
FEE
Na a a' d aAdress of piica t bon No.
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Location of proposed work - _ f
Describe full nature:of permit requested ;
Insurance on file with Town es .no ate policy expires
Name of Insurer -
o Approximate time for completion Desiredstarting, to -
'
Call before you dig ticket tJo.
Show sketch, of proposed work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLMgl) �
P Applicant is responsible for contacting the Polio Depuanent and CALL BEFORE YOU DIG. ,
I agree to furnish to the Town of South Windsor the amount 'of bond or deposit required ends
reimburse the Town of South`-Windsor for any expenses incurred by the Towa for tnsintenance or
wont in connection. with this permit and that I am familiar with and dill abide
by cue r a
regulations for pntnits as outlined in the Toxin.of South 11 Wdsor's iPsvem[eat'Cnt.Ragutahtotis i `
Signed
F APPROVED: : DATE APPROVED; ATE / ---`;
Supt. o ighways` � Town Engineer
-- FOR INSPECTOR: Date work started Date rom�piee$
- u .icient note 14�ation receivi_d.,__XeA___ no s �e
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- Unusual conditions encountered
11�Iaterial ali s attached., -
-. lj y"es" ao Dated--for errnanent rep$ r
Signed
. spoetor