HomeMy WebLinkAboutDrain Layers Permit 152 Norton Lane w
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nit No. 3069 Town of South Windsor, CT
a 02/14/2001 Street Excavation Permit
piration Date 02/14/2002
scrip:
Applicant Location
game COX COMMUNICATIONS t312 iORTbN LANE
Addr. 801 PARKER ST .
06040 CT 06040 .CABLE
Phone (860)432-5211
s
App l i cant ag rees to`', urn i sh T Rvn „� Si%utfi.`W�i`ndsor the amount of bond
required and to reimbpjr" e b Mown o South Mf; ixdsor for any expenses
incurred by the Town , or a "ttenanc y r r pai a k .i connection with this
permit and that app l i csmt i.��'�.f� ` t^: t tit and i„�1 � bide by the rules and
regulations -for permits e'r uti ineti !n thW, Tc ti. taf,. 'South Windsor 's Street
Cut Permit Manual .
* PERMIT T .,Btl,:KEp7 'ON" 'J08- .� i"TE, A1T" .ALL TIMES.
Issued by T itle�17—DLN
Date Comple d ,_ Inspected By �,
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR -
PUBLIC WORKS DEPARTMENTQ�j
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm
Address of Firm d Phone No. 40
Location of proposed work _T 5 cl 1.9 SF= �Art;IFF
Describe fully nature of permit requested ..iQgm i r_A7rV
Starting date
Call Before You Dig No. I p pp 0 Approx.time for completion_
Traffic Services Control No.
Show sketch of proposed work or furnish To be Iled out by Town of S
two copies of separate drawing outh Windsor
Pavement Cut
Indicate North
Prop.size of cut
No. arts
Amt. of Deposit$ by
/,c 4— Cash Check
Gv2 J� FJ
f� Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by
the Police Dept. and C.S.Y.D. date
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 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 WINDSOR 5 STREET CUT PERMIT MANUAL.
Signed: Date:
Title: .ane D.L#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
daass: Ph: 888344-7233
Mass ID#17930 Fax 781-721-0047
'r DIG SAFE NUMBER 2001 Q 7 665oF
Conn: Ph: 800-922.4455 DIG SAFE CLEARS ON AT 7:00 AM
Contractor#1167
Date. 101 EMAIL MUNICIPALITY
STREET ADDRESS & DESCRIPTION
(Apartments&Condo's must list name of complex-Or list the
number of feet from the cross st as well as N,E.S or W)j1j I L
Ci Oi v Q `
CROSS STREET
e.P P 1 �0 �� AREA MARKED ? YES
WORK: Inst kiz GATT! Utilities Notified:
DEPTH: W ,
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