HomeMy WebLinkAboutWater Street Cut Permits 383 Smith Stree BAND Ng e
TOV�N SO UT INDSOR
Am't 1t,09• PUBLIC WORKS DEPARTMENT Date
i TOWN HALL
t on File 1540 SULLIVAN AVENUE
Date of Expiration
SOUTH.WINDSOR, CT 06074 Permit No.
APPLICATION' FOR PERMIT Permit Expires
FEE $10.00 '2
Name and address of applicant
� hon eVc . 75 4 zj
,ZY4 _Sr,n C'c n Gag
a Location of proposed work IIIr 1
escribe fully nature of permit requested ,.
r
f
nsurance on file with Town yes; no Date policy expires Name of Insurer 7{� �( ; ,{ �r
a l_z 4 Approximate time ,� r completion
„ :,. ! dc. Desired sta,x .,ng date Call'before you dig td&et Zoo.
�G24 V
Show sketch of proposed work or h 2 furnis copies of separate a, drawings
'4i.i '--'�M'",/�'f'Sj`• irk.itt.•�
0
'•1 1. � "
O (.
o `
Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
Y agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reiinburse the Town of South Windsor for any expenses i
work in connectionncurred by the Town for maintenance or repair
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 (Pave` ent Cut Regulations.)
Signed
ILL
APPROVED: DATE APPRCiVD:
Supt: of Highways DATE 3'"—/?-��
P?711T
own Engineer
FOR INSPECTOR: Date work started
, Date completed
u'ficient notification received: yes noType of repair: Perm.—Temp.
Unusual conditions' encountered
h4aterial slips attached: yes no Dated for Permanent repair ,
Signed
Inspector