HomeMy WebLinkAboutCAble Street Cut Permits 15 and 25 Benja Permit No. 2730 Town of South Windsor, CT
Date 06/22/1999 Street Excavation Permit
Expiration Date 06/21/2000
Descrip: CABLE TV SERVICE ..
Applicant
Location
Name COX COMMUNICATIONS 0'02C EN�AA �4,LN WAY
Addr. 801 PARKER ST.
06040 CT 06040
i�ld`f'k 'CABLE
Phone (860)512-5000
Applicant agrees to urn ithe Tip to =f t ,Windsor the amount of bond
required and to reimburse ' te, Tows a �Wthi , rrvar any expenses
incurred by the Town fo"r rqaakpten flr �pait k connection with this
permit and that appl ipant ° fs 'r a0drl wide by the rules and
, s ,
regulations for perms t ' i edit t � f Sc`uth Windsor's Street
CutPermit Manual . ° a
* �* PERMI TOE,�' F�,�� ,
� AL� LvT1ES.
Issued by
Date Comp Aetd Inspected By
APPLICATION FOR STREET EXCAVATION PE RMIT
TOWN OF SO-LTH_ __WINDSOR----
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
r FEE $25.00
Name of Firm
Address of Firm Phone No.
Location of proposed work p+l.
Describe fully nature of permit requested
Starting date
Cali Before You Dig�No. �- ® Approx.time for completion tl
Traffic Services Control No.
Show sketch s proposed work orfumish To filled t b Town of South Wind
two copies of separate drawing sor
Indicate North _Pavement C
Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash()Check#
Cut size after Perm. Patch
No. Cuts
to I Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by-------.
the Police Dent-and C.B.Y.D. date
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: (O a R
Title: �t'-� t' �O��
e
i D.L.#:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard FormAPermitAStreet Excavation Permit.doc