HomeMy WebLinkAboutTest pits for gas main location Street C 70078 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER F STREET CUT PERMIT
DATE: 06/08/07
GIS ID: 37509999
FEE: .00
MUNIS APPLICATION# 200700862
ON TI DATE:
TE:
06/07/08
APPLICAN'
OCATION
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NAME: YANKEE GAS f F; " xTM<n'`
':.:r FE ;`'`` T$AH... `ROAD
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ADDRESS: 112 PROSPECT HILL
OF§OUTH WINDSOR
AN AVE
ASTW WINDSOR, > WIJ
�'I� DSOR
WI�I CT 06074
PHONE 860-292-2242 Ji. fi
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RK DESCRIPTIO
N: TEST
GRAHAM ROAD" 6i .:.:.:,,:
APPLICANT AGREES TO FURNISH THE TOWN 'p SOUTH"
E :C%w H t M( T F? .B01rID REQUIRED AND TO REIMBURSE
Q S
THE TOWN OF SOUTH WINDSOR FOR ANY XPE S S- -3 TE`, 0"CM1 MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE)W,%PL d.' f t§.� I T I' .p'W WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SC)UT'l�.V 3SR•£S S E T i fi'PE 1vIIT MANUAL.
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ISSUED BY DAT INSPECTED ECTED BY
6/8/20073:16PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: -)cao )(5 CONTRACTOR: gNt%ZsL 6AS
LOCATION:
ADDRESS:
------------
TYPE OF WORK: .
DATE INSP NEEDED:
DATE INSP:
INSPECTED BY: �A
WORK IN
.� PROGRESS:
INPUT:
DATE:
�r^RrniT# t/C C/Z1
APPLICATION FOR STREET EXCAVATION PERMIT *0010
TOWN OF SOUTH WINDSOR )Oa��)v
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm y) l Phone No.
Address of Firm I A P`re-6V f U` H)LL i:i` L.Nn1 —57;t
Location of proposed work
Describe fully nature of permit requested n
P sit" CULvLI,Vs
Starting date , j}�' G I, ,f-
Call Before You Dig No. aoo'�aSaZ Approx.time for completion 7 !)Ei-Y'
Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Indicate North
Pavement Cut
� Pro size of cut'P��':�CD CvLVEll1 p•
No. cuts
Amt. of Deposit$ by
0-9 W H O\ R� ()Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
IgOL.E 5
Amt. Due Payee$
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: �x &Wa
Date:
Title: No lea EVC-VC D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc