HomeMy WebLinkAboutStreet Cut Permits 106 Natsisky Farm Roa (3) 1300023 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/15/2013 -
GIS ID:62300106 FEE: 0.00
MUNIS APPLICATION# 201300283 &PIRATION DATE:
APPLICAN j LOCATION
NAME: YANKEE GAS D 196-NATSISKY FARM ROAD
ADDRESS: 112 PROSPECT HILI�R = �% i ;
TiJRG MARK D&MARY E
EAST WINDSOR, CI 0W_8&
G �NA' SISKY FARM R
� ( iJ`I`II WINDSOR, CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: REPLIACI GL�3lwlk
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APPLICANT AGREES TO FURNISH THE VOFSOUTD'+ AMN O B7ND REQUIRED AND TO REIMBURSE
jfiffllwmTHE TOWN OF SOUTH WINDSOR FOR AN E�EN`S�II<1C'�q�HE T WIG -0 a AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THQ—_QA�S4%WM t FTHA D W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF%SO 1TI lffl- -Gst T 1 E IT MANUAL.
ISSUED BY DAMMr TED INSPECTED BY
3/15/2013 9:11 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT N0. b
J 3
CON
TRACTOR: � va
LOCATION: l D I1 cc -f S t S
TYPE OF WORK: IGfp IS
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED❑ YES ❑ NO
AS-BUILT:
INPUT: — DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ Yn fee Cis Phone No. -�92-22►y
Address.of Firm—]!2 1`�-ro�,e�,F (-{�1 C � �- � r a 6p�
Location of proposed
: Job I�� 1�3
12� 12 5
I } l�l 191 t3
Describe fully nature of permit requested
(ice e.,b v lv&C
Starting date_ ?sa f Zo i 3 Approx°time fnr w:::p!eti^^ ,k
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
EsL'Size of Penn.PaWs)
EsL Pvt.Thickness in.
710(l
Est Unit Price$
Amt.of Deposit$
Total Due$ by
KA-Ts►sKy P�49 '1 SAD ( )Cash( )Check#
Permanent Patch
F 11-731
(G` L� FL I No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt:Due Town
_ BY
Applicant is responsible for contactin
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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 ERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINE THE TOWN OF SOUTH WIN SOR'S STREET CUT PERMIT MANUAL.
Signed: �oi
Date:_ 3/t/13
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES