HomeMy WebLinkAboutstreet cut permit 752 Pleasant Valley R ti
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSORr CT
FEE $25.00
Name of Firm "rn) ee S Phone No. (5?9 0,7- yoZ.
Address of Finn
Location of proposed work ,
Describe fully nature of permit requested
Starting date Approx.time for ownpletion �
Call Before You Di No. Traffic Swwces Control 4o•
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of sepai ate drawing
Indicate North gip•st m of Olt
No.cuts
••Amt of Deposit$ by
i
O Cash O Chedc#
` Cut size after Perm.Patch
r e No. Cuts
L.-4 fi�7
Final Billing t
AmL Due Payee$
AmL 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 WINDSORIS STREET CUT PERMIT MANUAL -
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Signed: 1 Date: Oo a
Title: .Ln S-tl Gk ch 0--T�fCl�. D.L*:
PERMIT SHALL BE KEPT ON 706SITE AT ALL TIMES
Standard Forrns\Permits\.Street Excavation Permitdoc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMITN0.: 001 CONTRACTOR:
LOCATION;
TYPE OF WORK:_
-DATE INSP NEEDED: DATE INSP: 21
INSPECTED BY:
WORK IN
PROGRESS: ✓ ' ' C - t
1 6 ri1
AS-BUILT:
INPUT: G� i
DATE:_ I 3 (
W/2007 Town of South Windsor INPSEMON REPORT 07
"j 800140 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/13/08
GIS ID: 72900752 #;"; ` `� < FEE:
.00
MLTNIS APPLICATION# 200801241
"flRATION
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APPLICANT : ;` M � x .
,p3 > ,OCATION
NAME: YANKEE GAS # �� .„
ADDRESS: 112 PROSPECT HIL R� A. ANT VALLEY ROAD
ORL�ALLEN R&SIMONE R
EAST WINDSOR,C
ANT VALLEY
WNDSOR,CT 06074
PHONE 860-292-2242 r r
WORK DESCRIPTION: ao
INST
APPLICANT AGREES TO FURNISH THE Tb.VOF 3)IJ �3UNT°QF BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AwI RI�Sff IN .���
> a , , _ FO m1�1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AI'PL C T E 'I I II ND ALL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S(, 4 T tc uT p IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/13/200810:51AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***