HomeMy WebLinkAboutGas Street Cut Permits Pleasant Valley/G i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3062 Contractor YANKE E GAS
Location PLEASANT VALLEYO GARDEN CIRCLEAddress 112 PROSPECT HILL RD
Type Work GAS E. WINDSOR CT 06088
Phone No. (860)292-2242
Date Insp Needed - Date Insp.
T i me I nsp Needed `Tne
Inspected By
Work in Progress
Input (N""` Date
Pt8irjMA No 3062 f'r Town of South Windsor. CT
Date � �I 5/2001
1 , l Street Excavation Permit
- .Expiration Date 0"1 /25/20 2-
Descrip. CAS MAIN FOR- PLEASANT 'MEADOWS SRD
Applican
Location
Name YANKEE GAS + ,P,LEASANt- V&1-LE*@ GARDEN CIRCLE
Addrn 112 PROSPECT MILL'
E. WINDSOR CT T�,P of -Work GAS
Phone ( 860 )292-2242-,
Appi i c a n t agrees o �arr*�rsh t �:� owe of.' SoUth-Windsor the amount of bond
required and to re' rand- c9i `5outh ,Wi.sndeorry for any expenses
incurred by the To r�-�fo� �i�i ni enan � �1r• repair, worl� in connection with this
permit and that app 1�T� wrj th �%n�d. w*i�1' abide by the rules and
regulations `for per mitspul"iritrti:' he;;To
wn 'of South Windsor's Street
Cut Permit Manual .
I
j * ERMIT TCf. K ET, (71ja8., 5I TE AT ALL TIMES.
Issued by _ ,1 l
.0 C Title _.'_�� '���'i►'�
-- - --
Date Comp 7 et �� ' 0 7
�U Inspected By ._
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
_TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firmer Phone No: g a-
Address of Firm ( ( — a y
Location of proposed work
Describe fully nature of permit requested t1 , CUM can SJ2 ry S
Starting date 1
Approx.time for compl ti
l.all Before You Dig o. p.10 a 113 U Traffic Services Control No.
FIndicaote
tch of proposed work or furnish To Iled out T wn f
s of separate drawing �. - be fi by o o South Windsor
/V -.� t Pavement r��
North _ Prop.size of cot .
No.cuts
!_ \- Amt.of-Deposit$ b
f r
Y
O Cash O Check.
Q� 'Cut size after Perm. Patch
No. Cuts
o-
\� Final Billing$
V�
jai. Amt.Due.Payee$
Amt. Due Town$
Applicant is responsible for contacbn 'w-puv gt by
the Police De and C.B.Y.D. �11 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 TOWN OF SOUTH WINDSORIS STREET CUT PERMIT MANUAL. FOR PERMITS AS OUTLINED IN THE
Signed
Date: L) /
Title: 1'1/ D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc