HomeMy WebLinkAboutCable TV Street Cut Permit 77 Autumn Dri .Permit No. 2573 sown of South Windsor, CT
Date 05/04/1999 Street Excavation Permit
Expiration Date 05/03/2000
Descrip; CABLE TV
Applicant
;
Location
7
Name COX COMMUNICATIONSw UT DRIVE
Addr.. 801 PARKER ST.
06040 CT 06040 T, �
Phone (860)512-5000 ° CABLE
Ap,p1icant agrees � � th Vindtr
or the amount of bond
required and to re i mku ;l"o � '' rth r� any expenses
incurred by the Town �f6 ��en � , it � '�epai r �� l- I connection with this
permit and that appl i rfit^"��
anA11 , a,i de by the rules and
regulations for permAs� `is11 South Windsor's Street
Cut Permit Manual .
* * PERMIT TO 8 � 'I F� t ', TTE" T ALL TIMES. �
(r'
Issued by
Date Completed _ Inspected By/
F 303
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
�r—
Name of FirrnCt' )q Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested C A.SIE
Starting date Approx.time for completion Qj
Call Before You Dig No. o Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
SW Final Billing$
fe�,A Amt. Due Payee$
C.lt' 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• t
Title: -- D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc