HomeMy WebLinkAboutGas Main Street Cut Permits Intersection Permit No. 2294
.awn of south 4indsor, CT
Date C2/1 3 .1 S,9 i ,treet Excavat on Permi t
Exp i r,.at'i on ()ate o2,, 1 3/ 1 -iq?
Des ;rips *INT DARTHILL & I RUMBULL iji {�o mA4, 'f,R UMEsU�._t_
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App ji r; zri r. ui.ar + r
Name YAN .EE GAS PARTkT,QUC
A.ddr . "�.r�, BCo, �? ,
ENFIELD CT ObC i6z TY�e °O� VJt�r� : AS
Phone
Applicant, agrees to ftirrt i sf . the Tawri` of Soui~h Windsor the amount of bond
requited and to reimburse the Trawn of South Wfndaor for ariv expenses
incurred by the Town :for, rriai n'tenanc# of " repai r "Wor' , 4,n c�onriect i on with this
Permit and that applicant Ys famiTi wjtft, a�nd . wi`11, aoide by the rules and
regulations for permits as outl fined in Lt,e 7cr 'n Of South Windsor ' v- Street
Cut. Permit. Manual .
PERMIT To BE KEPT 'G? J68 .SITE AT ALL TIMES,
Issued by - 7Itie
Gate Completer
Inspected By
`: 4
J
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
s TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm \`°� c. Phone No.
Address of Firm 11 Z. `V�'r®-7�. Q:-c
Location of proposed work -T)ca'< `t u ; \\ '1 1 . 11
Describe fully nature of permit requested 1��Xll CXv CN._ ! c::,
CA IS-Cb
Starting date +1 Appro .time for completion
Call before you dig no. Q-7 eA •Z2 oS TJS�7 j Traffic Services Control No.
Show sketch of proposed work or furnish To be f1Ued out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut '�V
No.cuts
Amt.of Deposit$ by
()Cash() Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt.Due Payee $
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 1 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: �Z . T 1 Date:
Title: I fY n C3 ..'9 e e / D.L.# 23 Ll 1 -7 3 '_ C%6 -
PERMIT SHALL BE KEPT ON J013SITE AT ALL TIMES
20' &OPE RIGHTS TO BE CRANED DETENTION
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