HomeMy WebLinkAboutStreet Cut Permits 9999 Slater Street (2) 1200037 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
STREET CUT PUBLIC UTILITY
DATE: 04/03/12
GIS ID: 83409999 = ;
MUNIS APPLICATION# 201200328 ;, = FEE: 00
EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS 1IDRES ,; 999 SLATER STREET
ADDRESS: 112 PROSPECT HILL AD , IWN SOUTH WINDSRO
��
EAST WINDSOR,CT 060�4,8 -
40NOLLIVAN AVE
JT�WINDSOR, CT 06074
PHONE 860-292-2242 gg
,.
WORK DESCRIPTION: EXCAVATE TIwil
fiTIOLSOITOI
APPLICANT AGREES TO FURNISH THE TOWI OFk.
SOU THDjT = OJT gD SQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPE_ISES IN ��> EZO�VI�I FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLI AIT IS FAMIIAR WIT4I AID VEIL--Z ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S4ITI l�rll?1DSRT OUT.PI RMTT MANUAL.
ISSUED BY ATE N I'E TED INSPECTED BY
4/3/2012 12:07 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERmrr NO.: qc)o GONTRACinR: 9
LOCA7ION: a �,
.TYPE OF WORK:
'DATE INSP NEEDED: z /�
DATE INSP.
INSPECTED BY: B-)>
WORK IN
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED El YES ❑ NO
'AS-BUILT.-
INPUT:
DATE: Y
W12007 Town of South Windsor INPSECnON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
EE $.215.00
Name of Firm
Address of Firm , Phone No.
UJ
Location of proposed work S
Describe fully nature of permit requestedc� r�.Ec ,�
-----------
Starting date
Approx.
Call Before You Dig No.
time for completion :i � f`
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North leis section to Ise fiu�i.u�ti.
Town of South'Windsor
Pavement Cut
No.cuts
Est'Size of Penn.PatctK$)
Est.Pvt.Thickness
p Est.Unit Price$
Amt.of Deposit$
Total Due$
by
t )Cash( )deck#
Permanent Patch
No. Cuts
Size of Patcfxs)
FXC ai 4"TG J
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is re nsif�le for contacti
the Poi"ce De t.and C.B.Y.0. Da _
AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WO
TO REIMBURSE THE
CONNECTION WITH.THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS F IN
OR
PERMITS OUTLI THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date: 2'7/r Z
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES