HomeMy WebLinkAboutGas Street Cut Permits 91 Pine Knob Driv (3) Permit No. 2524 ?'own of South Windsor, CT
Date 01 /21/1999 Street Excavation Permit
Expiration Date 01/21 /2000
Descrip: REPAIR GAS LEAK
Applicant
�' °
�� " Location
Name YANKEE GASF �pg NB DRIVE
Ak
Addr. P.O. BOX 1030RN a
MERIDEN CT O6450
Phone (800)989-0900 ' k SAS
Applicant agrees to the T� S , p it the amount of bond
required and to re i mbO Tova
� h Wrr any expenses
incurred by the Town i�or~ r�a�� eDa, , , air
permit and that appl icani; � a rk � connection with this
. ,, � � d i de by the rules and
regulations for permit& J,n h T� fpth Windsor 's Street
Cut Permit Manual . 17
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ny
* * PERMIT TO � � # � , T T ;LL TIMES.
Issued by �. �,JA t Y
Date Completed Inspected By
L �4-
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 C QS Phone No. r�R D-
a y
Address of Firm SOS c+ 7 ) d -
Location of proposed work ci( inc Kn 0 b 01r.
Describe fully nature of permit requested X C +C) +r 20_S �eCJt�
Starting date ) 9 Approx.time for completion ] $ q 9
Call before you dig no. 101 q q C);)-o I-I R-I 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 C� Prop.size of cut
1 No.cuts
Amt.of Deposit S by
()Cash () Check p
Cut size after Perm. Patch
No.Cuts
I
! I Final Billing $
�APP'bx• 31
Amt.Due Payee S
Amt. Due Town S
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 RWMBURSE 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:
Title: lQ L, )�l G\ .a�� D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES