HomeMy WebLinkAboutInstall ground bod Street Cut Permit 20/ Permit No. 2553 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD OR"CArV`--, ,AUTUMN DRIVE
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Applicant Location
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Name COX COMMUNICATIONS �� �'� %� r � E &40
Addr. 801 PARKER ST
06040 CT 06040 yp CABLE
Phone (860)512-5000
App 1 i cant gag ree h .w ' 0"" 4117( r,11for
Odsor the amount of bond
required and to rei�ur tie " o � �� uth an
1 , „ y expenses
incurred by the Towns Ao` � R rep" �� vo�c i n connection with this
permit and that app`.ir : r � i 1� abide by the rules and
regulations for perri� Lil g k �f, South Windsor 's Street
. Cut Permit Manual . a mt°
* * PERMIT TbJ SITEAXT ALL TIMES.
Issued by � T1tla
v
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Cam-[ /*l�I Phone No.
Address of Firm
Location of proposed work 5i ��sry
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. pPf-b 6 D-1744 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash O 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: Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON].OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Pennit.doc ,