HomeMy WebLinkAboutGas Street Cut Permits 161 South Satelli'nit No. 2366 I-own of South Windsor , CT
10I03/1997 Street Excavation Permit
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rANk,EE GAS 316.1 SOUIJ ! SATELLITE
P.O. Box 1030
MERIaEN CT 06450 Typesof Wdr,. GAS
to (800)989-0900
Applicant agrees tv `furoi,sh=.'�the Town 'of South W3ndsior the amount of bond
gquired and to reimburse the Town of South Windsor for any expenses
�c.urred by the Town for ma i ntenance, or riapa 3 r wort- 10 connection with this
:rmit and that applicant is familiar with and w 11 ab'ide !ay the rules and
,gu l at i ons for permits as but 1 -i ned in the Town .of South Windsor ' s Street
fi Permit Manual .
* PERMIT TO BE KEPT ON,,JOS $ITE AT AL TIMES .
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_.-- _ ---- ----_-- Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
X BLCSE WINDSOR WQRKDTMNT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm cz o c, ( a r v : c Phone No. Z Q Z_ 2Z S 7
Address of Firm
Location of proposed work ;
Describe fully nature of permit requested x c_zxv c,�Q
Starting date L>c t., ka ctr 7 Approx.time for completion
Call before you dig no. 9 mo j 3 —Traffic Services Control No.
Show sketch of proposed.work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
I ( Amt.of Deposit$ by
O Cash O Check#
,.40' Cut size after Perm. Patch
No.Cuts
C> Gx� s!h Find Billing $
Amt. Due Payee $
Applicant is responsible for contacting Amt.Due Town $
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.
Signed Date:_ i (2d(Z/ A '7
Title: t r D.L.#
PERMIT SHALL BE KEPT ON J08SITE AT ALL TIMES