HomeMy WebLinkAboutCAble Street Cut Permits 15 Benjamin Way (2) --Permit No. 2565 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD FOR, ATV ,, ENJAMIN WAY
Applicant Location
Name COX COMMUNICATIONS a BETEht &25
Add r. 801 PARKER ST
06040 CT 06040 rk CABLE
Phone (860)512-5000 " `
Applicant agreeh ``
ry o dsor the amount of .bond
required and to rei` rr, ' e "� uth r for any expenses
incurred by the Tows d o in connection with this
permit and that app � rr ��
�1U abide by the rules and
regulations for perm �dA, �:" South Windsor's Street
Cut Permit Manual . � g�s
�3 s
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* -* PERMIT TtCEJ�3 T - T ALL TIMES.
Issued by
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 $15.00
Name of Firm i GG Ph Sj"2—s— �a
Address of Firm p/ one No.
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Cain Before You Dig No.�9g9 ZD� 1p� 7 Traffic Services Control No.
Show sketch of proposed work or famish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North
Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash{)Check#
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.B.Y.D. dateL.
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 OUTLI
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. WITH
IN THE
Signed:
Date:_
Title:
D.L.#•
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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