HomeMy WebLinkAboutStreet Cut Permits 15 Natsisky Farm Road (3) 1300022 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/15/2013
GIS ID: 62300015 If
FEE: 0.00
MUNIS APPLICATION# 201300282
PIRATION DATE:
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APPLICAN LOCATION
NAME: YANKEE GASHADD TISISKY FARM ROAD
ADDRESS: 112 PROSPECT HILL E GN&I ANTHONY&
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EAST WINDSOR,C TSISKY FARM RD
ititVINDSOR,CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: REPA
APPLICANT AGREES TO FURNISH THE iOWOF SOUTH ,IIxI� �1 AMCTIIT�F IND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN E NS1S' �/TI �I �dIUKAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH - ._MCA I-IS IDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN Ono WINS i l> CHI I E VIIT MANUAL.
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ISSUED BY DATE`- P CTED INSPECTED BY
3/15/2013 9:05 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f 306®a�- CONTRACTOR: id tD
LOCATION: / J
TYPE OF WORK:- /,?-e ta
DATE INSP NEEDED: DATE INSP: V1 r3/0
INSPECTED BY: -
WORK IN
PROGRESS: .
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE: h qb s
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No. 0
Address.of Firm 11'2-
Location of proposed work
22 21 r 4-7 -78
Describe fully nature of permit requested Pept'aice uKr-b
Starting date 3/2oI2013
. Approx. time for completion � n1��r►hs�
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'tMndsor
Pavement Cut
No.cuts
Est.'Size of Penn.Patch(s)
Est.Pvt.Thickness in.
[r7$ V E
I a Est.Unit Price$
Amt.of Deposit$
Total Due S by
_ ( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
[15] Final Billing
a
Amt.Due Payee
Arnf.Due Town
By
_ Applicant is responsible for contactigg Dat _
the Police Dept.and C.B.Y.D. —
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
PERMITM OUTLINED IrHE TOWN OF SOUTH DSOR'S STREET CUT PERMIT MANUAL.
Signed: — �S
Date:_
Drivers License ff:
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