HomeMy WebLinkAboutGas Main Street Cut Permits 343 Clark St TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No., 402 Corl. YaCtor YANKS" SAS
Location rAddr„9,a 117YpPgSPECT: HILL RD
Type Work G ''s
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• Permit No. 4027 Town of South Windsor, CT
Date 07/05/2005 ° 'x•^ Street Excavation Permit
Expiration Date 07/05/2006
Descrip
A c PPliant .on
Name YANKEE GAS 3$'3 CLARK`' T;REE;£`
Addr. 112 PROSPECT HIL .,
E. WINDSOR CT 068 "j fFe oFc,&iCxk GA�a
Phone (860)292-2242 ::
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Applicant ant agrees"tcs fia:rk'is'i ,the .T.o.�r�;;xeef:,;S:E�tt,�h Wir���i� the A ''unt of may bond
required and to re:' ice' .....
4 x s.ebs T f` sr.. .. sor E` .:ate . X
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incurred b th ""'
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Y ,£� ..ttl�:���i^^�.ena�Yee>;:•a�`<r.�:.`�'�.�'`•''::c3Y .;>1.>':,:
;,... ::.:.�;.,....::. k' xs:::: o nect, on with this P � ''n.
permit and that app'1 :eant":' itq '<:,;:.:: .}ass''''."..s:::::y�s :3:2 >ab. ce 'b''" 'he rules and
regulations for perm-Its y
g p a. s as`<>;ou'�1`tie.c2;;�ri"'�'1' `€s'F �aik•><i�:>S.o-�i�h<.Winclsor's Street
Cut Permit Manual.
r * PERMIT T'O.. '6 E`
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ivlm rVK 5 I KCET EXCAVATION PERMIT Y0z -7
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
O TOWN HALL
1540 SULLIVAN-AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm C?
Address of Firm ,�. C Phone No. (9 6 ra ,��-
Location of proposed work 3 .�
Describe fully nature of permit requested ..ct' ' jd ,�'
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a (d N� 4�'e A Cr 12 4 1�7 -
Starting date__7r
Call Before You Dig No.2r,-) 5'0 3 Approx.time for completion_ iQ y
17�_Traffic Services Control No.
Show sketch of proposed work or famish
two copies of se arate drawing Indicate North This section to be filled out by
Town of South Windsor
# 3 q 3 Pavement Cut
— 4:2.' No.cuts
Est..Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est:Unit Price$
Amt.of Deposit$
Total Due$ by
O Cash( )Check#.
-Permanent Patch .
S No. Cuts
o
� C5 Size of Patch(s)
-- - - Final Billing
C L_ ,gRK cr .
V- Amt.Due Payee,. ..- .
G 00 d Amt.Due Town `
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Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Date
1 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:_
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES