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HomeMy WebLinkAboutTelephone Street Cut Permits Slater Stre .' r gS �MIT Date 11 j( `" 1�Ii7M, E 'P�r��] 't Noi T-- tSOJIYt!1D r, r OR, e 06U74 Ftnxist Ecpires a e;o. 4Expir t 4 1� 's I R s r — AP� LIC a I�T ' %'T Phone e Dame and address of applicant t 'r� .� t�r'�►l�I+...,?`�4iG�R - OM- �.il{•-,�0, �O 111►R1Git♦ LF. i4�J:'�1 ���`'+ Location:,of proposed work 5 ` Descri'li. fully nature of permit requested `' srn.�.«.� -sag T ctoa Insurance on. ile . L Town es no Date policy expires k f Name "of Insurer:. �A ^1�Q - o. Approximate time fr "cpm l.etion D;es�re.d starting date Mkt li� 4 � pP o p o =: Show ,sketch of proposed work or furnish 2 copies of separUe"dra*ings c _DK t.%,A:nfr 8q HI11 .3 U ys _ - d f+' U � Z, CALL BEFORE YOU DIG. aAgphcant is responsible for contacting the Police Department and 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 repaiY work in "connection with"this permit and that I am "familiar with and will abide ;by the roles and rezgulationso%;`permts as outlined in the Town of`South Windsor's (Pavement Cut Regulations.;► ^.l 1Affi r Sl4RftS•f:4.ee g APPROVED: ' DATE I APPROVED� � , !t.� ` DATE hway�s o n neer� Date completed �N :TO�?; Date,$worktarted.: ton > ,ece�veeyes no Type of-repair: Perm'. Temp # Ue is ,dittos encountered r :' : r'� �1tta�hed (yeas riQ Dated for Permanent repair - y Sigt>�ed sU} Ines` c o.r