HomeMy WebLinkAboutStreet Cut Permits 60 Natsisky Farm Road (2) 1100077 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/06/11 -
GIS ID: 62300060 FEE: 00
MUMS APPLICATION# 201100705EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS - = ;ADDRESS: 60 NATSISKY FARM ROAD
ADDRESS: 112 PROSPECT HILL OWNER: AVE,RYHN C&KERRY R
EAST WINDSOR,CT 8 60 NATSISKY FARM RD
SOUTH'WINDSOR,CT 06074
PHONE 860-292-2242 ;
WORK DESCRIPTION: REPLACE-CURS VALVE
APPLICANT AGREES TO FURNISH THE TQWW OF SOUTH WiNDS(}R THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY"EXPENSES INCURRED BY TffE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT.IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOiITH WINDSR'S"STREET CU I.PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
7/6/201111:23AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 / hOD 7 .? CONTRACTOR: ��a vi t'pe
LOCATION: Coo ka -is i s 1c y Fg is m 2 c�
.TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: I c l
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: ' DATE:
W/2007 Town of South Windsor INPSECRON REPORT 07
06/27/2011 MON 15, 09 FAX 860 292 2202 0003/003
K APPLICATION FOR STREET EXCAVATION PERMIT
�Y.
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH'WINDSORf CT
FEE $25.00
Name of Firm Phone No.
Address of Firm
Location of proposed work' ILJ
Describe fully nature of permit requested
Starting date AppmL time for aampletion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish To bfill out by Town of South Windsor
two copies of separate drawing
Pavement
Indicate North Prop.size of cut
No.caps
'Ant.of Deposit$ by
RE`Aft ()Cash()Check#
Cut size after Perm. Patch
No. Cuts
�a
o! Final Billing$
Amt. Due Payee$
Rmq►� 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 A5 C)URiNED IN THE
TOWN OF SOUTH STREET CUT PERMIT MANUAL.
!" Date:
... Signed:
Title: J!�'Fto D.L.#:
PERMIT SMALL BE KEPT ON 300SITE AT ALL TIMES
w>;
_:. Standard Forms\Permits\Street Excavation Permit.doc