HomeMy WebLinkAboutCAble Street Cut Permits 15 and 25 Benja (2) h
.--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 F ,.BENJAMIN WAY
Applicant Location
Name COX COMMUNICATIONS , ' BE'fEi425
Addr. 801 PARKER ST
06040 CT 06040 � ��� � � � r i�r1x CABLE
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Phone (860)512-5000 � � ' �� �
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Applicant agreed o dsor the amount of bond
required and to rei a ut 4h Vr for any expenses
incurred by the Towjp ep �cinconnection with this
permit and that app irpa vlk abide by the rules and
regulations for perm s � fhSouth Windsor's Street
Cut Permit Manual . '
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* * PERMIT T FKEfi `�dTE� 3T ALL TIMES.
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Issued by title
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 $15.00
Name of Firm i C� Phone No. �d `�� :c��ya
Address of Firm
Location of proposed work �..,:, �, rA /�¢
Describe fully nature of permit requested / ,2
Starting date Approx.time for completion
Call Before You Dig No. 1999 O 2DJ ODD Traffic Services Control No.
Show sketch of proposed work or furnish To be 11'illed out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
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:
:-Z,— -Date:
Title: Z D.L.#:
t,
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc