HomeMy WebLinkAboutGas Street Cut Permits 428 Niederwerfer APPLICATION FOR STREET EXCAVATION PERMIT
cv / TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. 8 60 -a;P a
Address of Firm eT re-)'2
Location of proposed work AV .c9,F- L-v T e iC .eJ �i .,+- T ./,
Describe fully nature of permit requested C)c c.4v.4?i i , f2 a /g-B!, Si f�N�o
5 '-: SS 4i�2�'�4 ev t-- .s2 • o io i2 h""�c�cE ��4S t' vice
Starting date / .-.9 �/ l9 S 7 Approx.time for completion
Call before you dig no. 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
7'XP-006LA-t 040 SEd✓«C, No.cuts
1 p J S Amt.of Deposit 6 by
I�) O Cash()Check#
P2�rsFy Gi4S 42,41- � Cut size after Perm. Patch
�I
G� s a2" /N It�) No.Cuts
Final Billing $
Amt.Due Payee S
Az /.0 A2 - 2 w F R /10
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: ' -/O
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Town of Soutrl Windsor , ;T
Street Excavation Per-,nit
2266
Permit No. 02110/1997
Date t
Expiration Date O2/ 10/ 1998
i-ocat
Descrip =
Applicant NIE.QERWERF.-r:R ROA
0+,428
Name YAN'K.EE OAS hype f.,Wort� GAS
.
Addr • P.O. BOX 339
ENFIELD CT 06082
tj 29�'--2236 � u��, Windsor the amount of bond
Phone (86 ) so any expenses this
agree to furnish the T°Wnuh�Wi' cor connection. w1t,h
Appl i cant 9 7 mburse the -TOW , ®pay r ,ytr4� i n the rut es and
required and to re � aYaide by c reet
Town form ntenance ` wi hand ill :
incurred by the n 'the 'T,own' of So�t�7 Winds.,�r � �t
that aApl scant �� fami�� 1�►r, .
for permit's ds oul �ned 7
Permit and
regulations
Cut Perri Manual
PERMIT TO BE
EPT 'JN 'JC)S BITE AT ,;Ayr_ TIMES
Issued by —_s. -- Inspected iffy
� �
----- —�
Date Completed _ ----___-