HomeMy WebLinkAboutGas Street Cut Permits 88 Stanley Drive (2) Permit No. 3021 Town of' South Windsor , CT
Date 08/29/2000 s-treet. Excavation Permit
Expiration Date 081'29/2001
Descrip: EXCAVATE TO REPAIR GAS LEAK
Applicant Location
Name YANKEE GAS 0088 STANL.EY DRIVE
Addr . 112 PROSPECT HILL RD
E . WINDSOR CT 06088 'type of Work GAS
Phone (860)292-2242
Applicant agrees to furnish the Town of South Windsor the amount of bond
required and to reimburse, the Town of; South ;Win,dsor for any expenses
incurred by the Town for maintenance o.r ,repair work in connection with this
permit and that applicant is familiar with and wl'il' abide by the rules and
regulations for permits as 'outlined in the Town of South Windsor' s Street
Cut Permit Manual .
* * PERMIT TO BF; KEPT ON JOB SITE AT Ai,, 'TIMES.
Issued by Title
l 1
Inspected 6y
Date Completed __-_._
30a
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOPv CT
FEE $25.00
Name of Firm tan 0 V S Phone No. 29 � -a dy a
Address of Firm , o
Location of proposed work g t
r.
Describe,fully_nature of permit requested Fx r�Qy tr
Starting date Approx.time for completion
Call Before You Dig .o. Q�Z&op I a5 Traffic Services Control No,
r1ndicate-Nor
ow sketch of proposed work or fumish
o copies of separate drawl To he filled out_ b g of snuth Windsor
Peveme�nt C��*
Prop.size of cut
No.cuts
Amt.of Deposit$.ice by
{)Cash O Check#
Cut size after Perm.Patch
No. Cuts
Final Billing
Sac 5` ��9 afea Amt. Due Payee$
Sfar)' r. 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.
Signed
Date: a(�
Title':�` D,L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc