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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3724 Cont,ra:et"&r YA�'&:;:GAS
Location 0834 FOSTER STREET Ad'dres;S; is 112<>::P'RC?S:PEC ::.HILL RD
Type Work GAS , WINBS0 CT `D:6088
Phone N:o ($r:p.)292":2242
Date Insp Needed _________ w Bate Ixp `� '
Time Insp Needed ------------- _ Tame Tns
Inspected By �R '
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Work in ProgressSRI—
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• Permit No. 3724 Town of South Windsor, CT
Date 05/27/2004 Street Excavation Permit
Expiration Date 05/27/2005
Descrip: REPLACE GAS SERVICE �: ` Hpt36E
Applicant Locat:aon
Name YANKEE GAS 38 § POST: I5TR$ T
Addr. 112 PROSPECT HILL RD
E. WINDSOR CT 06088. Type n.,Wor GkS
Phone (860)292-2242
Applicant agrees tQ::ifurff9`h the,Town cat St�uth Windsor 'tEe mount of bond
required and to reimburse the Town of South Waxidsorf anj. expenses
incurred by the Town it malntenaxae Gs " r pazr iucrk z connection with this
permit and that applicant �s £amilir vait:h and ti111 ab# e `b,y the rules and
regulations for permjts::>as outlanedr:: 1 ,'G TgYyTx:::o SQ:uLh 'Win8sc5Y's Street +
Cut Permit Manual.
* * PERMIT To BE •KEPT QN �p� '�TT� AT ALL ;T1ME5
issued by --- ! I _ T i t h e —_----_
Date Completed — ---___-- Laaapeted BYE.. all
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm t�lK E� — Phone No.
Address of Firm 'FOS Gr 1�L h E T W I l��' G
Location of proposed work V ArR taus LOCArrypy5 - p?') "I,, (PA(i S w,U
vN Sknc si N5 of
Describe fully nature of permit requested R h e- " Sne 6 e " w .� �� ��►
Starting date b N t Approx.time for completion 10 t 0
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish ViSTZ 3)4" To be filled out by Town of South Windsor
two copies of separate drawing HOKE' STML SBRVIO
A'=- Pavement Cut
Indicate North ���� Prop. size of cut
P . No. cuts
j,
Amt. of Deposit$ by
Rom) ()Cash ()Check#
31
Cut size after Perm. Patch
S7r=l:�' Rc�n
'1 1 5 rFEr On) No. Cuts
19 S I Et:P MAW/ ✓ Final Billing $
17
L TEFL, Amt. Due Payee$
3 y FoSr r � Amt. Due Town $
Applicant is responsible for contacting 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: z:L= `1/ Date: ���/� 7
Title: D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc