HomeMy WebLinkAboutGas Street Cut Permits 627 Pleasant Vall Permit No. 3049 Town of South Windsor, CT
Date 011/09/2000 Street Excavation Permit
Expiration Date 11/09/2001
Descrip: GAS SERVICE
Applicant Location
Name YANKEE GAS
Addr. 112 PROSPECT HILL RD a&,27 ',�PLEJSANT VALLEY
E. WINDSOR CT 06088 'fype ;of Mork GAS
Phone (860)292-2242
Applicant agrees to i $b4th'Windsor the amount of bond
required and to reimburse ti�� Town ai* sough wiridsor for any expenses
incurred by the Town n repar atcrk ":i r� connection with this
permit and that applicant fa► i1 `ar 3th and w:- l4 abide by the rules and
regulations for permit a �itlt; '1n � To�rrt ;if South Windsor's Street
Cut Permit Manual . ;
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* * .PERMIT 8E KEPT 4P4 JOB' SITE AT, ALL TIMES.
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M 40_ APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
- TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR CT
FEE $25.00
Name of Firm V
` Phone No. oEq o�- D-304' ._
Address of Firm r
Location of proposed work &a A C0 l e.
Describe fully nature of permit requested e—*C0.\1f t r�5 t ll QQS S2�V c
Starting date I i t Approx.time for completion a
Cali Before You Dig o. ,Q�4laOC� Traffic Services Control No:
Show sketch of proposed work or f(ftish To be filled out by Town of South Windsor
two copi s of separate drawing _
Pavement.Cut
Indicate North Prop.size of cut
�1 Al No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Penn. Patch
T No. Cuts
I CL,IN Final Billing$
Amt.Due Payee$
In, Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.and C.B.Y.D.
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.
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Signed:
Date: / 1 4e Zoo
_-1" '
Title: � 0.� D.L.#•
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
--Standard'Forms\Permits\Street Excavation Permit.doc