HomeMy WebLinkAboutStreet Cut Permits 205 Natsisky Farm Roa (2) 1300024 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/15/2013
GIS ID: 62300205
MUNIS APPLICATION# 201300284 FEE: 0.00
EXPIRATION DATE:
APPLICANT/ �
NAME: YANKEE GAS LOCATION
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AMADREsDNA SISKY FARM ROAD
ADDRESS: 112 PROSPECT HILLG - = ER
EAST WINDSOR, Cl (T S — - (�rTTLINOEL&GAIL
'/ 2 5 A I SKY FARM RD
G - ,v INDSOR CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: REPA1 C
APPLICANT AGREES TO FURNISH THE PD
WL01 SO OV&AND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC L p AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIPCAiT IS FAIUL�r�Zi
FOR PERMITS AS OUTLINED IN THE TOWN OFFOIfI ?WISR''. AL `SIDE BY THE RULES AND REGULATIONS
1T IsEIIT MANUAL.
ISSUED BY DATED PJCTED INSPECTED BY
3/15/2013 9:35 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ()0 0 0? CONTRACTOR:—\/a a tee
-
LOCATION: ) 0 5 Val 1-
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP
INSPECTED BY: 63 D
WORK IN
PROGRESS:__ c�-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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S/FORMS/TOWN OF SOUM 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 $25.00
Name of Firm Y¢,^k 64-C
Phone No. Ate-292 22iq
Address.of Firm- i.l 2 �P���-I— t<-k,')1 �,��
Location of proposed work �J- —�5 k-�
Describe fully nature of permit requested_ `lam ,G ce c"Y,6 �✓�I.�a'
Starting date_LS Zo13
Approx.time for completion 6
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est.-Size of Penn.Patc t(s)
Fo5 R2-1
Est Pvt.Thic
kness in.
Est Unit Price$
Amt.of Deposit$
Total Due$ by
IsiSkY ( )Cash( )Check#
Permanent Patch
No. Cuts
I Size of Patch(s)
Final Billing
Amt.Due Payee
Amt Due Town
BY
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Datp
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 0 INED I E TOWN OF
F SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: a Date:_ 3/►3/Zc r 3
Title:_
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES