HomeMy WebLinkAboutGas Street Cut Permits 528 Niederwerfer Permit No. 2288 } Town or SOLlth Windsor, CT
Date 02/10i1997 �> Street Excavation Permit
Expiration Date 02/ 10/ 1 996
Descrip:
Applicant _ocatiorr
Name YANk;EE GAS0628 NIEDERWERrER ROA
Addr . P.O. SOX 339
ENFIELD CT 06082 Type 0f'.., 14r'r: CAS
Phone (860 )292-2236
ur nisFthe ToW
Applicant agrees to fi tt ' South bdit7dsor the amount of bond
required and to r-eimbwrSe tiro ,"Town: �c�- puth Windsor for any expenses
incurred by the Town for maintenance or r�pai r W'0' i n' connection with this
permit and that applicant ie familiar w1th and 'wi31,. abide by the rules and
regulations for permits as outlined in the ' Tow n► of South w.indsor ' s Street
Cut Permit Manual .
* * PERMIT TO SE KEP`1 bN "',40B 'BITE^ AT .ALL TIMES.
Issued b�+ �.� _�__ _. T i't I e
Date Completed _w� _�_- Inspected By
C�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm c i14:1 s C-, 12
Location of proposed work N Xe p
r}:;Pz✓.s d ,x -S :/ �/ s,�,�✓Ya ,. y 5'6, sa�; S moo,
Describe fully nature of permit requested E'3( c i4 Y ffN�
5 /�4SS �/ 14�14114 rg J-- % o.w io >2 A"7 cE dci59S S'�,Pvicc'
Starting date zweq /.F 09 7 Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish _—� To be filled out by Town of So Windsor
two copies of separate drawing —r— Pavement Cut
Indicate North Prop.size of cut
jyj71G/Q L /"v SE'27- /V tJlG E
T/f. yGiy 01- No.cuts
/A)a 56 \ Amt.of Deposit$ by
I�I O Cash O Check#
PrLarsFv c_.¢s 2.4.1- � Cut size after Perm. Patch
(I
No.Cuts
Final Billing S
Amt. Due Payee $
/,C t7 - 2 w eX AZ AV
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.
10<
Signed Date:
Title: D.L.#t
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES