HomeMy WebLinkAboutRoad boar trench Street Cut Permits 97 t BOND TO ! OF SOUTH WMSOR N° i a i 9
Arn't Req. ._.PUBLIC WORKS DEPARTMNT Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit E
APPLICATION OR PERMIT Expires
FEE
Name and address of applicant r�'pC19Ake Phone No.6
Location of proposed work_ jAj j6S? ,c�, 1/Sp 917
Describe fully nature of permit requested I ,��,�
Insurance on file with Town yes no Date policy expires
Name of Insurer _
.°c. Approximate time for completion Y Desired starting date
F (0 Call before you dig ticket No. 4?,4/1/19
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Show sketch of proposed work or furnish 2 copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED
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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.)
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Signed
APPROVED: DATE APPRO D: ML��aDATE`ZZ 4/,1&9A
Supt. of Highways - o nee
FOR INSPECTOR: Date work started
Date completed
u ficient note ication received: yes no ype of repair: Perm. Tem
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Material slips attached: yes no Dated for P ermanent repair
Signed
Inspector
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