HomeMy WebLinkAboutStreet Cut Permits 102 Beelzebub Road (2) 1100184 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/19/11 -6
GIS ID: 09000102 FEE: 00
MUNIS APPLICATION# 201101520aw IRATION DATE:
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APPLICAN LOCATION
NAME: YANKEE GAS � � A RE NrBE ZEBI ROAD
ADDRESS: 112 PROSPECT HILL= s al T �AL
EAST WINDSOR CT 8
y '�Y� E ,ZEBUB ROAD
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%- GkJT4 INDSOR,CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: INSTL
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APPLWND QUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN FISE U] �TT �7IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEM�� A1V IA$ H A� WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O IT MANUAL.
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ISSUED BY DATE" SPECTED INSPECTED BY
12/19/20119:02AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:- Ll 00 Y CONTRAC DR: '--/ai 1 lae-
LOCATION: 1 d,?,
'TYPE OF
DATE INSP NEEDED: DATE INSP:�1
INSPECTED BY: B 1) .
WORK IN
PROGRESS:_ /-I 8 ' q Mf-(k +0
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT: DATE:
W12007 Town of South Windsor INPSECfION REPORT 07
12/09/2011 FRI 15: 16 FAX 860 292 2202 0003/003
APPLICATION FOR STREET EXCAVATION PERMIT
{
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH-WINDSOR, CT'
FEE $25.00
Name of Firm Phone No. t��x •' �?�`7'Z— "Z"'z_ `
Address of Firm I
Location of proposed work' a �'�"�E
W. Desai n re requ
:.
Starting date. Approx time ftx QompldW
Cali Before You Dig Traffic Services Control No.
Show sketch of proposed work or furnish TA be filled„a_MbgTQwn of South Windsor
two copies of separate drawing
Indicate North ProP'•size of cut
4
No.cuts
162. "Amt.of Deposit$ try
t�Cash Check
# .
F Cut size aW Perm.Patch
Aje ra No. Cuts
_ . Final Billing$
Amt.Due Payee$
� t id1 Amt.Due Town$
Applicant is responsible for contacting by date_
I 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 M(PMES 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 E CUT PERMIT MANUAL
Signed: Date
:: . Title _ D.L#:
� 71'?
PERMIT SHALL BE KEPT ON 3013SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permitdo.c _