HomeMy WebLinkAboutGas Street Cut Permits 109 Hillside Driv Permit No. 2332 Town of South Windsor, CT
Date 08/01 /1997 Street Excavation Permit
Expiration Date O8/01/1998' _ a
Descrip: EXCAVATE 1 'X1 ' VACUUM HOLE T-O BOND„ SERVICE
Applicant Location
Name YANKEE GAS Q4 9 ,. LXLL$IDE DRIVE
Addr . P.O. BOX 1030
MERIDEN CT 06450 of. Wog} ., SAS
Phone (800 )989-0900
Applicant agrees to furnjsb'� the Town. of South ;'Windsor the. amount of bond
required and to reimburse ,the Town,,,"of S-Outh W1n6sor ,for any expenses
incurred by the Town for. miffi enance: �,or°"repair warK T connection with this
permit and that applicant is,:fart t ar ,w�i th .and �i,i 1 abide de by the rules and
regulations for permits as . out,l i neck :in the Town. oaf� South Windsor' s Street
Cut Permit Manual .
* PERMIT TO BE KEEN ON, :.JOB ,SITE AT ALL TIMES.
Issued by .. r
Date Complete _ Inspected By
r.Y 1
APPLICATION FOR STREET EXCAVATION PER T
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm r iS�Q GrCxl�' < r v C -S Phone No. 7 gZ - Z
Address of Firm
Location of proposed work 1 m Ck C:12. ��C
Describe`fully nature of permit requested F
Starting date 7 1 29 2 17.7 Approx. time for completion
Call before you dig no. 9 -7 ZclQj Z 8 /6 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit $ by
(L
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing S
Amt. Due Payee S
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
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: ] /Z9 A �
Title: f- / C�C1 �170 C' < D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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