HomeMy WebLinkAboutGas Main Street Cut Permits 711 Governor Perm t No. 3058
Gate 12/12/2000 Town of South Windsor, CT
Street Excavation Permit
.. Expiration Date 12/12/2001
Descrip:
Applicant
Location
Name YANKEE GAS 071,i , GO,V RNORS HIGHWA
Addr. 112 PROSPECT HILL`00' ,
E. WINDSOR CT Ofib&6 Typerv; of Work GAS
Phone (860)292-2242
Applicant agrees i;p fin 1 th 'the TAf«►l : of Sctith.- Windsor the amount of bond
required and to re7m k e wh outh-",Vtindsor for any expenses
incurred by the Tornfa3 ' ante p � ®rkl in connection with this
��eh re
permit and that applt, asr" oth m .ti wi i 1� abide by the rules and
regulations for pernt'e �.'ou . ,of;, South Windsor's Street
Cut P
� ermi t Manual .
* PERMIT` T E KEPTN JC} iE AT ALL TIMES.
�Issued by 1 itl eZC1h
Date Complet d Inspected 8y _
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �'1 a c,�ct¢ �� ` C c ��� -Phone No. _2 q'Z-'Z 2 S'7
Address of Firm Z"�«,�-o � �v� ,� �` - L k ` � r
Location of proposed work_
Describe fully nature of permit requested
Starting date-b a, % t-Zos�,o, Approx.time for completion- w C.t )r
Call Before You Dig No. Ob Oo a1 a Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
- :V--,l
Cut size after Perm. Patch
No. Cuts
Giwernbrrs "Vil, Final Billing$
Amt. Due Payee$
3 x S 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.
Id-) w aov - - - - - -signed:- Date:
Title: � W% D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc