HomeMy WebLinkAboutGas Street Cut Permits 490 Niederwerfer w.jndsor , ,CT
�. OW of South permit
Stree a Excavation
Permit No . 04/24/1997
Date
Expiration Date 04/24/ 1 `'sS
Des criP STREET CUT pERMIT FOR ANkE rA ovation
App.� icant EUEiWERt=ER ROA
a
YAIVr,EE
GAS Tyk
Addr . e , SAS
Nameme Bob P .O.
MERIDEN - CT 06450 the amount of bond
Phone (800 )9g9-0900 W . enses
the ,Tows► ref So�uh for any exP this
Tees to furr7 h . of ,S0uth � f6d'sor.
ApPlicant a air word In connection with and
to re i mbure tl i,e Town or r,ep the rul e..
requi red and for; m �ntenaric+� v�i hand ,wi l I aside by Street
the Town i f ami l i ar f South �i i t+dsor ' s
incurred by i.t,at, aPp }cant n tie TOW vl,,,,
permit and -for permits` asuti,ned
re9uIatIons �
cut Permit Manual .
� TIMES
�'sl�i 'JOB r
MIT T� EpT �
* PER.
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issued by ------ - Inspected BY
Date Completed
APPLICATION
OWN OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 7 Q n K2o G,:,n 17-14Q-i d i C-c'S Phone No. Z q Z.--,Z7-S 7
Address of Firm I t 7_P . o< N \-"i. Sc
Location of proposed work �-t a ch t" i CL r�_�z r : s n_c � ZA.
Describe fully nature of permit requested o a x e-z- -,!ck�-'e- mac' R\\
c � ol
(L-
Stari. g date " 1 z B ! �'7 Approx.time for completion Z8/9 7
Call before you dig no. 9 7/'7Q>I G.'7/ Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit.$ by
O Cash O Check 8
Cut size after Perm. Patch
No.Cuts
'3 Final Billing$
Amt. Due Payee$
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: / b� Date:
Title: e la[ i 17-Q e- D.L.B
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES