HomeMy WebLinkAboutGas Main Street Cut Permits 71 Edwin Roa Permit No. 3059 Town of Soutn Windsor, CT
Date.-- ~' 011/05/2001 Street Excavation Permit
Expiration Date 01/05/2002.
Descrip:
Applicant Location
Name YANKEE GAS EDWIN ROAD
Add r. 112 PROSPECT" H I L 4flr;
E. INJSOR CT 06.08 Type of ;Work GAS
Phone (860 )292-2242
Applicant agreed tp ft�rni,gh th rown of SoUtKh " lindsor the amount of bond
required and to re1 outhIt�ror for any expenses
incurred by the Town p,r marnter)ange qr repe(,ar ;�wor.k in connection with this
permit and that app l s - fir ti th1�te.w` l i abide by the rules and
regulations for perl,n pu+ �n+��..ih ,the �'c�t�n, i f South Windsor's Street
Cut Permit Manual .
* PERMIT',-,, S.I" 'E AT ALL TIMES .
Issued by _ "1Jale
Date Comp1e Inspected By —
l
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm Ila ,
Location of proposed work 1 �tA ,
Describe fully nature of permit requested Cc4 r
Starting date 1181 1 Approx.time for completion 1
Call Before You Dig ho. 0 Traffic Services Control No.
Show sketch of proposed work or furnish N To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
C' Amt.of Deposit$ by
O Cash O Check#
I Cut size after Perm. Patch
No. Cuts
Final Billing$
d a! EA W /1 ? i _ Amt. Due Payee$
K� Amt. Due Town$
FAppplicais res sible for Zcti�ng by date
the Police De t. 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 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: �" a Date:
Title:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc