HomeMy WebLinkAboutGas Street Cut Permits 575 Rye Street Permit NaM .
227g
..Date �12/'iG/19g7
• Town of Sauth Windsor,
Expiration Date 0� Street excavation PermiGT
Descr•ip; / i'�/i99t3 t
'�p� i i��ar�t
Name YAN�E,E� UAS � � �_ac:�t?an
Nddr. P.O. BOX: 33g t�575 fi'�� STt�i"ET
FtiFIE�D CT i76082
Phone (8nD)292-�236 � , � � , ,. �., ,
TYpe Of Work 4�4S
Applicant agrees tp 'Furn��� th ��
required and to reimburse 'the, Town of�n �f So�rth
incurred by the Tawn for Winds°r the amount
Permit and that a S�auth Windsor i�ar of bond
ma i ntenanc�' �or��r'epa i r �wCyr�, � any expenses
regu7atians far �pplicar�ix ,i� fam��3 � igr°. w� irr` connec;tian with tt��s
Cut P perm? is as ��� �n�ad in and wi,1 1 abide b
er►n�i t Manua 1 . ��'�e .TcSW� of Y the ru 1 es
South Windst�r ' ar�c�
s Street
�` * PERNfTT Tv BE f�FPr
Issued by �'"_ ��„ �+�'� �1�� `SITS.
'�
_ _ ,� � AT. ALL, TIMES .
Date Comp�e to d '.. ---- �= _ ?.i t 1 e -,,,_��.�,��,-�-�,,,,.
_-------- T n s p e c r_e d B Y
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN
WORKDTMNT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00 �`
Name of Firm /t lri¢S Phone No. 6 gKO o2 g.2 • -'2 2S'-2
Address of Firm
Location of proposed work 2 i S -V S
`J, 2: S Y /q s'S' ?._Sf
Deescriribe�f�ully nature of permit requested ,C XGs4 ✓d T- /A/ 'Q'e' t-c.�P S/ �itsoo
,� -37 06 A O. w ?d /2 .pGACE rr�9S S1�iAG//Gf�
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
7y/q/G,4 L x w soAT /v= +v SE/t vcc
7-/// v v e=-/7` O1,:,9 SE/e e! / C E No.cuts
NOV S E Amt.of Deposit$ by
(1 Cash(1 Check#
I( Cut size after Perm. Patch
is
No.Cuts
II Final Billing$
Amt.Due Payee $
Amt.Due Town$
Applicant is responsible for contacting
the Police Dept.and C.S.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 Date: a /
Title: y'=/L�G� ZIU6 - D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES