HomeMy WebLinkAboutGas Main Street Cut Permits 327 Clark St Perm I t�
Date 10/25/2001
o: 3223 Town of South Windsor, CT
{
Street Excavation Permit
Expiration . Date 1012512q�2
Descrip. GAS SER-V` G°E TO NEW HOUSE-BORING UNDER ROAD
Applicant Location
Name YANKEE GAS 03Z7 CL,ARK STREET
Addr. 112 PROSPECT HILL RD
E. WINDSOR CT 06088 Tvp o Wor. k, GAS
Phone (860)292-2242
Applicant agrees to furniehm theo�Jtt of St�uta Windsor the amount of bond
required and to reimb rs 'trt ', QWn o#�" o t n'd$0r, for any expenses
incurred by the Town enariee, t, r ,repa 1 r,:: k ` in connection with this
permit and that app l i pa-nt . 9�f am7 l ar'regulations for and.: yl l ', abide by the rules and
permito s Out ��e� ������� ,.To�h� .af South Windsor's Street
Cut Permit Manual .
* *{PERMIT to BE KEPT t3N .JOB . S1TE AT ,AALt TIMES.
Issued by Titl®
Date Completed - _ ' Inspected By
C
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit Nor"$x Contractor YANKEE GAS
Location 'VM' SMWMAddress 112 PROSPECT HILL RD
Type Work E. WINDSOR CT 06088
Phone No. (860)292-2242
Date Insp Needed � Dae° np.
Time Insp Needed
T The A
Inspected By
Work in Progress RIO . rc
Input '�j�, Date
f -
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Fire Lori 14 xf a#j Phone No
. .
Address of Firm ; " W
Locatio of pro wo
(d laj uc l a 4)
Describe fully nacre of R req, c C' _
Starting date — Appr&_time for cor"Pletim..... .,
Call Before You Dig No. Triffic Services Contra No.
Show sketch of proposed work or furnish Mft filled Mm ofspum mundar
two copies of separate drawing
SIZ
<S ,{
Indic atte North tj
V b .sine of out
No Gd5
�o
-Amt.of Depmt$ by
Cash O m&
Outsize after Perm.Patch
d- — No. Ctrs
Final Billing
Aft Due Payee$
Amt.Due Town$
Applicant is responsible for contacting by daW
the Pollee DeM and C.B.Y.D.
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 CONNECrION 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: � — . o Date:
.. A ./
Title: L�.lEG1�l a D.L*:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Pemtitdoc