HomeMy WebLinkAboutBore for CATV crossing Street Cut Permit Permit No. 2917 Town of South Windsor, CT
Date 02/16/2000 Street Excavation Permit
Expiration Date 02/ 15/2001
Descrip:
Applicant Location
Name COX COMMUNICATIONS Ot►4U A stl n. Ci rc I
Addr. 801 PARKER ST .
06040 CT 08040 Type of Work CABiE
Phone (401 )82 1-1 g 1 9
Applicant agrees to >furnsh the Towfi of South "Windsor the amount of bond
required and to reimburs -SO uth Wandfor for any expenses
incurred by the Town fir tenan ,F Qt"-repa -r pork •1 f1 connection with this
permit and that appl zca�t fart .aa wi` h arm w` 1 ), abide by the rules and
regulations for permlo s`:_as Wt71nedl, ;.�n the Tc�wrr� of So uth Windsor ' s Street
Cut Permit Manual .
* �* PERMIT ' BE INEPT ON:: 40B SITE AT ALL TIMES . * M
Issued by — T?t 1 e --
Date Comp l"d Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR )
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of firm �7� ��Jm M Ulm t cr�d Phone No.
Address of Firm M 0 o t
Location of proposed work 4-VA /.1 USa-i,y e— '
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. 09ft Traffic Services Control No,
Show sketch of proposed work or furnish - To be filled,!out by Town of South Windsor
two copies of separate drawing
Pavemer,Lt Cut
Indicate North Prop.size of cut
: l'1
No.cuts
�dCk l� ` Amt.of.Deposit$ by
`(� O Cash O Check#
Cut size after Perm.Patch
SLNo. Cots
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: 5 ,d 1- Date: l� w
Title: Ste- D.L.#:
PERMIT SHALL BE KEPT ON 7OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc