HomeMy WebLinkAboutCut and repair sidewalks Street Cut Perm TOWN O SOUTH" �VIN soft0966 ,
PUBLIC WORKS DEPARTMENT
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* TOWN HALL ved: yen
1540 SU V
LLl AN AVENUE .
SOUTH WINDSOR, CT 06074
Date of Expiration
' Permit Expires -
"PLICATION FOR PRRMIT
FEE, h l `
' Name and address of..applicant one No. 2Z3-��'$'7
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-ocaRon of propose workf L t
Describa fully mature of"permit requested
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Insurance on file with Town no ate policy expires
Marne of Insurer - f ,artF G( q
j All oximate time for completion ? Desired starting to .
Ca . before Y dig ticket t1o.
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Show sketch of proposed work or furnish 2 copies of separate drawin 's
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ly
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c OSHA PXQUXM- ENTS MUST BE FOLLOWED
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Q Applicant is tespocubk for contacting the Police Department and CALL BEFORE YOU DIG. r
I agree to furniah to the Town of South Windsor the amount of bond or
�eh0burse the Tmm of South Windsor for an ea deposit requ� and t4
y penes incurred by the Town for mainteftam or repair
work in connw6m with this permit and that I am familiar ar th and
regWations for .abide by the rules and
p®rmits as outlined in the Town of South Windsor's IPavenjsnt Cut .j
Signed
APPROV 9D: DATE APPROVED: DATE
Suet. oHighways
eer
OR IIVSECTORz Da
te work started Date completed
V u flc` Ent notr ication recei
nhsusi con lions encountered= e
" atal""ghp°s attached• yes no Y Dated forPermanent repair'
Signed
s ector