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HomeMy WebLinkAboutGas Street Cut Permits 297 Pleasant Vall Town of South Windsor , CT 2329 Street Excavation Permit Permit No• 08/01 /1997 Date 1998 BOND SERVICE ' ration Date 08/01 f VACUUM HC�-E TQ Expiration Descrip: EXCAVATE 1 X.1 V Location Applicant 029� PLEASANT VALLEY Name YANKEE GAS 030 Typ® �f. Work SAS Addr . P.O. 80X MERIDENgCQg00`��0 800)98 i nds r the amount of bond Phone ( a ' S©u1Wh enses cth Wizd�c�r far any exp this Applicant agrees to frnieh the To inconnectionwith air' . b the rules and fired and to reimburse �! tenance or reP _,1� . bide y Street requ Town formain incurred by the 1 i pant i"s;�.fami- i.ar. yv"�_tl ;fin permit and that aepmits" s aUtline, �h the Town `Sodth Windsor s regul a sMaonuap Cut Permit y .. TT TO 8AT IMES. *�,PERM ttyF��- J T i t -- Issued by 8 � —� - inspected Y — insp � Date Comm) ;tep =w► APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS HAL -7117 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm `l r n'i N C � �-� C� r y C tZ S Phone No. Z 9 Z - 7 J Address of Firm 1 \ 7 7 G c-'* 1A V\ : �" --\' , , &—^e- Location of proposed work Describe fully nature of permit requested 1 FA- �X- _`F-� Starting date 7 j 2c� / 2-"7 Approx. time for completion ) c., Call before you dig no. 9 -ZZC1d)Z.&,d�'8 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 (1 Cash () Check# Cut size after Perm. Patch No.Cuts 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. `9 1 Signed: __ � _—_ Date: Title:- f /- L /c c D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Aw S C'�jo SKETCH Gc�nocl q t-(emu a.o'• c;zo INDICATE NORTH t y (ot q �Z9d� 2 �ScbB _ c= E3