HomeMy WebLinkAboutReplace Test Station on Gas Main Street 800097
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
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DATE: 06/23/08 'STREET CUT PERMIT
GIS ID: 69900047
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APPLICATION# 20 0800933 FEE:
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APPLICANT .;;:r<%`r<:}:..'...
AGREES TO FURNISH THE T+`
HE TOWN OF SOUTH WINDSOR FOR ANY`FX1§ BPSr fFIOIT Q?Bf3ID`REQUIRED AND TO R IIdC ,. EIMBURSE
CONNECTION WITH THIS PERMIT AND THE Aj'1 INr'II "s
: 11 flit"1VIATNTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF S' R:."': .:. .
TH '` I I`''ABIDE BY THE RULES AND REGULATIONS
C i17 ',ISR:.SSTftE$. i? R111! MANUAL.
ISSUED BY
DATE INSPECTED
6/23/200811:12AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_..iyc60q CONTRACTOR:_. a Y)
LOCATION:_ LA
'TYPE OF WORK:_ B e )a c -�esfi n n e4 3 M4) A-
DATE INSP NEEDED: DATE INSP: 14 2
INSPECTED BY: B
WORK IN
PROGRESS: �c , (kce� ,h rrc
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AS—BUILT:
INPUT:— DATE:_
W/2007 Town of South Windsor INPSECTION REPORT 07
F►rrLft,H I Iunt t-UK STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
K_ - TOWN HALL
1640 SULLIVAN.AVENUE
SOUTH WINDSOR,CT 06074
- _ FEE $25.00
Name of Firm ;jis tilL� phone No. S'6G
Address of Firm 9
Location of_proposed work. •dtr
Describe fully nature of permit requested
Starting date ' /0-- O
Approx.time for completion
Call Before You Dig No.7-60 Sb 4;y OCR Traffic Seniices Control No.
Show-sketch of proposed%Wk or famish
tw�o'copies of separate drawing :indicate North This sewouo he fill_
. - Townof South iM.ndsor
Pavement Cut
No•cats
Est.S e Rem PatdKs)
- Est Pt 119c tress_ in..
Est~Unit FWwa.
Attt.of Deposit
Total Due a by
O Cash( )Check#
-se
rmanent Patch .
"No. 'Cuts
Size of Paws)'
Amt.Due Payee
Amt;Due TO" .
Applicant W responsible for o6rt taoting
the Ponce.Dept.and'C.B.Y.D. Date
t AGREE TO FURNISH TO THE TOWN OF SOUTH WI
NDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINI S PERMIT
ANY EXPENSES INCURRED BY THE TOWN FOR.MAINTENANCE OR_REPAIR WORK IN
CONNECTIQN WITH THIS PERMIT AND THAT I AM FAMiL1AR WITH AND WILL ABIDE t3Y THE RULES ANO REGUI ATIWORK IN
PERMITS AS OUTLINED THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL:
Sign
Date;
Title: A61 Driver's License#: .
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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