HomeMy WebLinkAboutSewer and water Street Cut Permits 145 S 831 .
�: � Qlvu TOW�Y 4F SOrtJTI WIN�?S4R
1. Arn't Req, PUBLIC WOWS:DEPARTMENT FDate
. TOWN HALL
I on File9 1540 SULLIVAN AV NUE
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r SOUTH WINDSOR-, CT 06074
Date of Exp�.xation
APP �: TI P RNIIT Permit Expires
FEE $10.00 .
Name and address of applicant -�7`".41efe yNr
y 1.d.1C'. Phone No. �� S•G7c�/h'` ,
oeatf proposed work
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` Describe fully nature of permit requeste,
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Insurance on file with Town„ yes: no bate policy expires /
Name of Insurer_j-f ,e-y+t� �2w ��/S ��o-v�
hl o. App.,roximate time,, ar oCo pletion Desired start g date / 9'
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x' y u di ` ket r1o. ��� _ -
i,; Show sketch of work or:furnish 2 copies of separate drawings
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Applicant is responsible for contacting the'Police Department and CALL BEFORE YOU DIG.
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 an, familiar with and will abide by .the miles and
regubtions for permits as outlined"in the Town of South Windsor's (Pavement Cut Regulations.)
Signed, 7 'C_ 7'
APPROVED: DATE APPROVED• DATE
Sup of Highways o eer a:�
' FOR INSPECTOR: Date work started
Date completed
Suf rent`notification received: yes np: Type of repair: Perm. Tem
Unus'us.l conditions encouxitered p'
Mstevial slips attached: yes no aft to errnanent repair
Signed -.
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