HomeMy WebLinkAboutGas Street Cut Permits 35 Troy Road ToWn Of Soutn W� ndsor , CT
2'41 .i Street Excavation Permit
Perm! " NO—
04r(36;1998
Dai
Date
t)esr.r i p : CatiDU iT CRiDSSIN Locat!on
A.pp i 'i cant ~
CUaS T Ri?'Y ROAD
Name YAtaf<EU`XA {J;,O e of, yc�rk GAS
Addr .. P .O. T�,P
MERIDEN CT 06450
Phone 1800 )98"'O UO
the Town 4f South Windsor the amount o� bond
Applicant agrees to expenses
r re;pa r WarI -i n' conr�ect i on witru l ens and
required red and to re 7 mburse h "'Towrl�of S, uth W f'h 5or far anY the
incurred by the Town for main enan
l iaaht �� farn�l '1��r with and '~r i'11 abide by
permit and that apP out 1 i ned n the TUwr► of South i ndsor ' s street
regulations for permrt s a5
Cut Per,rnit Manual .
RMIT TO BE- KEPT CAN JL'S SITS AT ALL TIMES.
Tiltle
Issued by
Date Cornp i e
inspected By
� APPLICATION
OWON OF SOUTEXCAVATION
WINDSOR N PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Y46L,n< :E � Phone No. n�/� �— LZ"3
Address of Firm //oC fS'V' �'7� i-/<Gc.
r
Location of proposed work ;;Fag, @ ?�3
Describe fully nature of permit requested �.� c— C -fzuj,'T fd To"e,-,oj rl Motes oolvD
ZcS E70 --Ac ,6-1V0 '
Starting date 8 Approx.time for completion / D6
Call before you dig no. FIF 7 .r 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
Amt. of Deposit S by
rp
A.,00� '. O Cash(1 Check#
—rpoy 9�0 I�C2�vour Cut size after Perm. Patch
C ,� 99j No.Cuts
Final Billing S
Amt. Due Payee S
Amt. Due Town 8
Applicant is responsible for contacting
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 RF,1MBURSE 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'
Title: C /� D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES