HomeMy WebLinkAboutGas Street Cut Permits Neiderwerfer Road APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH W S R, CT
FEE • �0fje
Name of Firm �� � � ' • Phone No. Z /2 2 2 3 r
Address of Firm //Z
Location of proposed work 1�/L�D�72t�JF�t,YL /20
Describe fully nature of permit requested 7.J7X LC► ,.r
Starting date l/ /.3^ /p9.6 Approx.time for completion
Call before you dig no. 26 q6 OO 1 3 T 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 �
P41
Amt.of Deposit 8 by
Cash O Check#
cs-t46'4 Cut size after Perm. Patch
I No.Cuts
I
r
—� Final Billing 8
Amt. Due Payee 8
C�U�GTDN Amt.Due Town 8
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: 3— / '6
Title: , �
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
"own of Sou ti r Windsor , CT
Permit NO. 2263 ;street Excavation Permit
Date 11 / 13/1996
t
ExP i r`at i on Date 1 1 J i 3i 1997
Desor°i p : INSTALL MAIIN LINE�AT vNASE"-I=ARMS
l.ocat,i on
App'I i ant
Name YANItEE GAS NEIDERWERFER ROAD
Addr. P .O. BOX 339 Types of Word. GAS
ENFIELD CT 06082
Phone (8bD )2g2--2236
Applicant agrees to furnish the Town of south nforranye amount exxpensesof bond
required and to reimburse the Town o, ; South Windsor, with
incurred by the Town for mainter�aiarwithpair anc w°ll abiderk -in nbycthenrules ands
permit and that applicant iq familiar
regulations for permits as tjut'lined in the Town of Sut,t� Windsor' s Street
out Permit `Manual .
> PFRMIT TQ BE KEP4 OIL •1►Di SIZE Al ALL TIMES.
Title1 r
Issued b
Inspected By
Date Completed