HomeMy WebLinkAboutGas Street Cut Permits 135 Niederwerfer Permit No. 2.;12 Town of South Windsor , CT
Dats 06/24/1997 Street Excavation Permit
Expiration Date 06/24/ 1998
Descrip :
Applicant Location
Name YANt EE GAS 1 5 IEOERWERFER FAD
Add r. P.O. SOX 1030 -
MERIDEN CT 06450 War GAS
Phone ( 800 )989-0900
Applicant agrees to fur,rrish he' lb wn, d South V hdsor the amount of bond
required and to reimburse the `l'owrl" foUth Wi-t)dQr,..; o any expenses
incurred by the Town f6r., enan e' t r. pair `h :. i.n connection with this
permit and that applicant .i.�. famiIiAr Witht ,and W��:11.: `�b'ide by the rules and
regulations for permits-as outl h6a ;i_n tfta Town of South Windsor' s Street
Out Permit Manual .
* * PERMIT TO BE *.EPT".ON ALL TIMES,
Issued by
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Tvtle ,-
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Date Completed _�_ __�__ -- Inspected By
APPLICATION FOR
OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm i ac,\\&aa— G0.S �o c.r L2S Phone No. 2Sk Z-'Z 7-57
Address of Firm "R/�
Location of proposed work \"3 �cka_C� {a-C o
Describe fully nature of permit requested E T C_ass oA v lrc :c*1S)AI�c%\\ ct c:h,S S Q(,.I
Starting date Ck7 Approx.time for completion \
Call before you dig no. q 7 Z,5!0 1 G .22— Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
d
�o. 135 No.cuts
d Amt.of Deposit$ by
to
Col O Cash{ Check#
VVV Cut size after Perm. Patch
\\ No.Cuts
Final Billing$
Amt. Due Payee$
(;Wo-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 1 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:
7�
Title: j� /dam ,9 / D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES