HomeMy WebLinkAboutCAble Street Cut Permits 213 Brookfield i . -A ,
Permit No. 2692 Town of South Windsor, CT
Date 05/20/11999 Street Excavation Permit
Expiration Date 05/19/2000
Descrip: CATV SERVICE ,
Applicant
At* ,.
Location
Name COX COMMUNICATIONSSROELD STREE
Addr. 801 PARKER ST
06040 CT 06040 �
it
CABLE
Phone (860)512-5000
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Applicant agrees o� ur th S 1�1tnd or the amount of bond
required and to re i mt y"er e w.7c4 th y r� r any expenses
incurred by the Town fore " pai connection with this
�itena
Permit and that app1ictni; t � ar W � p ,a ide by the rules and
regulations for permits a ine ' .6
d in the Twoft. South Windsor 's Street
Cut Permit Manual
PERMIT T lfiEl� A JCS "STT ATE AL ..1MES.
Issued by
Date `Complet Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm t e Phone No U `o G
Address of Firm
Location of proposed work
Describe fully nature of permit requested_
Starting date 4POY7 Approx.time for completion A
Call Before You Dig No. qy F) 14 i el a Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
0?13 No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
fe 4 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.
k- Sll 7
Signed: Date: dd
i
Title: D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc