HomeMy WebLinkAboutDrain Layers Permit 311 Quarry Brook Dri Permit No. 3070 Town of South Windsor , C'T
Date 02/20/2001 Street Excavation Permit
Expiration Date 02/20/2002
Descrip:
Applicant Location
;
Name COX COMMUNICATIONS b x 03 ! i �tl1ARl BROOK t7RI
Addr. 801 PARKER ST.
06040 CT 06040
n� CABLE
Phone ( 860 )432-5211
Applicant agrees t l,"IfUj r� ,�th� Tc an #' Sa,t4tt. Wfhdsor the amount of bond
required and to reimbu a town rQf Math WA ndi�oi^ for any expenses
incurred by the Town f` rl.tenanc off; rspai rin connection with this
permit and that appl i .5 �fr. 't. rt anq _11aide by the rules and
regulations for permi s Ott �`it etl. n t Taw South Windsor's Street
Cut Permit Manual .
* PtMIT TO,'BE; KE°P' JQB. SITE. AT ALL TIMES.
Issued b y "T.i t 1 e
Date Comple a Inspected By _
s� -
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR --
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm a d Phone No. 15?420 —S
Address of Firm K
Location of proposed work 1 t [4�'Q.F'tR�/ ge,y nit
Describe fully nature of permit requested ..a% LI E
Starting date ea—AI&—b 1 Approx.time for completion rNk- A
Call Before You Dig No.,a=A2pw Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement �
Indicate North Prop.size of cut
No. cuts
Amt. of Deposit$ by
. �•�' Dc �� ()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
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 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'S STREET CUT PERMIT MANUAL.
Signed: tine. Q ,� Date: V� - bk
Title: a,,CX D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
Mass: Ph: 888-344-7233 /'�
" Mass ID#17930 Fax 781-721-0047
DIG SAFE NUMBER L O 01 v�1�W�7f
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Conn: Ph: 800-9224455 DIG SAFE CLEARS ON c;� c� 3 __Q ( AT 7:00 AM
Contractor#1167
Date `'- /01 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)
7D
CROSS STREET ,L AREA MARKED ? YES
:f WORK: Installing CAN Utilities Notified: ����.,� �� — � - D u 7 - 1-2<20
DEPTH:
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Pay,