HomeMy WebLinkAboutGas Main Street Cut Permits 68 Barber Hi Per•mi t iNo.
Date 229--.
02/ 1 Cry' 199 7
f �H !1 01 SoutEi d't7, , ^
t at i 0l) +~ t r ea cis,,r „7
�a�e �2; ii� ; r Exca��at.ic�n P D e s c r i p - 1 9 e r-,q l l-
App 1 i cant,
Name YA► KEE GAS Lac.at ors
Addr. P.CS. BOX: 33g
ENFIELD cT 06082
Phone ( 860)292-2236 1`;r�y� GAS
Applicant agrees tpfurn�sh .the,
required . Taws
and to re -rmburlse c7f-'sG�1tk� "W� ids r
incurred by the Town the "Town `of tau h W thG amount
permit and fo.r ma htenarlGe 1r1 laor ,"to?r of d,�nd
that app i i cant or °r"epa i r "w+ rk any expenses
regulatio'..,s rnr �. js fame l �i'sr' wYth 7n connection yith
perm a as out. 3 r rigid i n and W i" F 'ah de �, th i s
Cut Perrl� i i:. Manua i . the Tcar y the ru l es
n 'Of South W�nclsor ' and
Street
* PERMIT TO EE KEPT GN .JtEi `SITE-
Issued Issued AT AL _
Date r� r't 4 e
omP l eted
Inspected BY
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
a PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm_ Phone No. RCO - .29..?
Address of Firm 2 OS /c /--�/.�r
Location of proposed work /-?,oy 2 i3,f' /2 C ,Q s9 'olt ?
Describe fully nature of permit requested C v 91 v.4 T6 !iv ,tea h`r✓ �� /���
G.Q/fSS %4 zf/2^" o e `2. o. &o%.� /"'b .•2 t�L/�+ c �.¢s S�'/1 vac r
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be felled out by Town of So. WindsoC
two copies of separate drawing Pavement Cut
Indicate North Prop.size of out
'TyP/G.¢L /ti sE/�T' /iEr✓ S �,Lc✓�c E
7'y�/LOcI C-rt dG d> S,E2 u/G.0
No.cuts
�7---
)JG v Amt.of Deposit$ by
1 O Cash O Check ff
a U.GF 1 Cut size after Perm. Patch
INo.Cuts
IIFinal Billing 8
Amt. Due Payee $
es--.-q r
Amt.Due Town$
Applicant is responsible for contacting
the Police Dept.and C.S.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND 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 STREET CUT PERMIT MANUAL.
Signed: Date: 1-1?—10—/
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES