HomeMy WebLinkAboutGas Main Street Cut Permits 185 Commerce rmit 2236 Town of South Windsor, CT
tee 08/27/1996 Street Excavation Permit
piration Date 08/27/ 1997
scrip:,
Applicant Location
me YANKEE GAS tt85;WMMERCE WAY
dr. P.O. BOX 339 ,f�
EN' IELD CT 06082 Type 4?1= Work GAS
one (860)292-2236
Applicant agrees tO ;fure iah the Town of South Windsor the amor,Wt of bond
required and to reimburse the=Town,�af �Sotith Wi:rstiaor for any expenses
incurred by the Town for r ai ntanance o'r .`ripa i r `work i,n: connect i on w i th th is
permit and that applicant ` 14I' °farml'iar with and wf11. atide by the rules and
regulations for permits as t�jjtl i ned �7n° the Tou�n `,c South Windsor ' s Street
Cut Permit Manual .
* * PERMIT TO BF-ICEPT ON ..aaQ SITE, ,AT ALL TIMES .
ssued by Title`
ate Completed _ _ ___ Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
Amt. Bond Required PUBLIC WORKS DEPARTMENT
Amt. on File TOWN HALL Permit " WE 2236
Date of Expiration 1540 SULLIVAN AVENUE Date
Ins. on File O Yes O No SOUTH WINDSOR, CT Permit Efpires
Expiration Date FEE $25.00
Name of Firm WA 14-.f
Address of Firm ML-L /�,- � Phone No. Z�ZL3 f
Location of proposed work try//"�Ct$`k 1/ _
Describe fully nature of permit requested M r'T*LC L. Gwx -saywRts
Starting date g �" 6 Approx. time for completion
Call before you dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be tidied out by Town of South Windsor
two copies of separate drawing
Pavement Gut
Indicate North
4- �.+ Prop. size of cut
No. cuts
Amt. of Deposit $ by
(7AS Cash O Check #
Cut size after Perm Patch -
No. Cuts
_ Final Billing $
Ism
Or nmq Gr4t+4
Amt. Due Payee $ —.
Amt. Due Town $ .—
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I agree to funish 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 d regulations for permits as outlined in the Town of South Windsor's Street Cut Permit Manual.
Signed: "" - Title:
D.L.L.# -ZD.Z/ ADL/ 7 tG Date: ..Z7 14
PERMrT SHALL�.BEE'IOT ON "SlITE AT /LLL TL TIMES
APPROVED: ATE: .!� Z r
TOWN ENGINEER
FOR INSPECTOR: Date work started Date Completed
Signed Date
WHITE - PERMIT PINK- ST. SERVICES
YELLOW - ENGINEERING ""'t" GOLDENROD - FINANCE
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