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HomeMy WebLinkAboutGas Main Street Cut Permits 171 Commerce Permri t No, Date �� i 1 C�: y 06/11/199 own of South kPl rat ion L'JatP, f�{�j � i �tr iNirldSC7r I,�I Descri p: pE / 1 8 eet. , c;al,�ation Permlt �RRAINA tipq l 1 cant Name YANKEE GAS Location Addr. P.U. BOX 1030 MERIDEN CT 7 1 COMMERCE. WAY Phone ( 8F00 3 �i5C7 Type OfGA,(-', Applicant aJ.-ees to requ i red and to re Turn 1; the; T© of incurred b 1mbt.irse the Tour, of South Windsor' the Permit Y the Town f'or South �tinrisar f �r ar) amount. of band and that a main�enan�e or requ 1 at•ions for. qA ?cant 7�s repair W;):- , Y nPenses C Permits as' farm � �ar Srith and w� � � In connect;on with this Cut Perin i t Manual , aut 1 Y r►e r1 the abide by the r, Town at Sour. u les and h w ;ndsor "s Street I��sued h 1 Elk ? ON J-()B 'ITT AF .AU i.IMES, . Date r t t I e rlspeCteo BY ' APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR F PUBLIC TOW1VD DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE 25.00 Name of Firm 1 0-"a.¢, &as se-,.r:CALs Phone No. lq"1-.2257 Address of Firm_ i12 —'I?tosZa_c� Location of proposed work t'7► C �.r�rr n r o �1 a� Describe fully nature of permit requested Z C o Starting date !o i \ 0l7 Approx.time for completion lk Ma^�� Call before you dig no. 9 7 m /P, 4 Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts (� Amt.of Deposit$ by O Cash O Check# Cut size after Perm. Patch No.Cuts J C N>�a ¢c� Final Billing worko,c¢.�, Amt.Due Payee $ Gas rra:e� Amt.Due Town$ Applicant is responsible for contacting the Police Dept.and C.B.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: 4 /l/ 9 7 Title: Zn Q i�c � / D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES