HomeMy WebLinkAboutReplace gas service Street Cut Permits 1 X.
STS
BOND / TOW. OF SOUTH'
WINDSOR
Ain't Req, l. . PUBLIC WOPEXS DEPARTMENT Date
TOWN HALL
1. 't on;File— 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
l rate of;E pi'ration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00
Name and addre-s s of applicant Phone No.
Location.of proposed work fr ' .
6icribe full nature of permit re uested :' - �, ' 7 17 ; �...1-,� 7,.-/Y P 4 � ..� v!-
nsurahce on f `"g ,
ile o/ - yew. no" Date policy expires a
Name of Insurer
o Approximate time for .completion" Desired star9'n .date
5 ' Call before you d:igiitet '�
s�
Show sketch of proposed work or furnish 2 copies. of separate drawings
0
a
(D'
Aga+-.+4f-.r- .r=^+tcr.r Rt't^— __"""'r'...... ..,. _ .. _ -. �- - -. - ..,r— .. .. •-_. ...._ . _.-.�
44
�! Applicant-is responsible for contacting the Police Uie arttnent ar#d CALL B$FORE YOU DIG.
r
I::agree to furnish to. the Town of South Windsor the amount of'bond or deposit 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 pf South Windsor's. (Pavement Cut Regulations.)
t
APPROVED. DATEAPP ROVEDr DAT ": p
Supt. o 9ighways ' Town Engineer,
ok INSPECT dIR: Date work started Date completed
Sufficient,.notification r-gcei,e*,. yes no Type_of repair: -Perm. Temp._. _ .. -�
Un-usual COI1Clix oms-enc0untE".d
Material slips. attached: yes no Dated,for Permanent repair
Signed. u
SKETCH
• INDICATE NORTH
r
X7/li
S
i
x
C
e G u llYTO- /2 ! FPC)M 0
r
Lor 1
/
c1,
'71'° R 12 e'vr«
•
IJ SKETCH
�vt�cM�f
4v e,,,oc w�ycet
pgwi INDICATE NORTH
3
T a'
�r
j
ri /cam 3"
_ %
�Jo� �NV5
•
P 79 SKETCH
R�P�oX
INDICATE NORTH
i �
1 osetlf-
YS It
. 1�
i
egg
w
i �
w
z ,6,, Z
� sF� 63 6•. �
a 7S•�'• a
a:
la
PROP. LINE a
CURB LINE (z w
y /221'
�,t/NASR
CURB LINE
PROP. LINE
SKETCH
r 'Apt
INDICATE NORTH
�proc
Ap?ff
!F
I !
! !
Av STL