HomeMy WebLinkAboutGas Main Street Cut Permits 47 Ferry Lan .e
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3697 Cont r4. : >or""YANIZEP>:.;�AS
Location 0047 FERRY LANE ASs res.% <,.'i112 %OS.PEC.,.HILL RD
Type Work GAS E.., W1'kD :OR•;�CT "6:16088
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Date
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Permit No. 3697 Town of South Windsor, CT
Date 05/07/2004 Street Excavation Permit
Expiration Date 05/07/2005
Descrip:
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Addr. 112 PROSPECT HILT ; p
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Phone (860)292-2242
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plicant
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4•w ..;:;p:� .:��:t#�;�i Wind"s.ei:'f`>:.��e"'amo"n
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required and to t.h'
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incurred b the "> `"'y e TowrL. fo.x. la '•satnarr .. ;......`l<!:.:;;':>::::. :::
permit and that a 1 c...
t✓ c`",.: i;-` aah�cten with this
..c�; 'lyz" 1e rules and
regulations for permi`.s as, &0t ,ih:e „lid"t'"` <»;'""` °`;% f'
. p :;2s�'^'S'OUt..12 Winds[ir's Street
Cut Permit Manual.
* * PERMIT TO<BE KEPT 'OAI J(7B , TT
Issued b
Y _ .:.:.. ... :. ::: .
Date Completed ---- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firma-
Address of Firm C
location of proposed work
Describe fully nature of permit requested S a
Starting date Appm One for co npietion214
call Before You Dig ho. 00 Lf 110300 Tramc Senrioes control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
v
Indicate Nc th Prop•size of but
AA No.outs
"Amt of Deposit$ by
(.)Cash()Chedc#
Cut size after Perm.Patch
a `fKy (S9 CQYeo-S No. Cuts
Final Billing$
�t'N — - Amt Due Payee$
{_ Amt Due Town$
Applicant is responsible for contacting «c by date
the Police Dept,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• Date: 51'-71 w4
Title: ros ak&OCA oS& D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Sbvet Excavation Permitdoc