HomeMy WebLinkAboutCAble Street Cut Permits Right side of 3 Permit No. 2576
Date 02/17/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL8' GROUND RODW PATV" =� ",'C�AMBRDIGE DRIVE
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Applicant
y �, Location
Name COX COMMUNICATION �°`�°5 ` `
Addr. 801 PARKER ST. � "� �� s`� OF 80 AND BETWEEN
06040 CT 06040 �"
Phone (860)512-5000 Fe TYp Wr CABLE
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Applicant agrees A " r 1 . h a>
required and to rei� "� °f tdsor the amount of bond
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incurred by the Tows �t`',;h �e �r;, for any expenses
permit and that app� c,' in connection with this
regulations for ' ` abide by the rules and
permsa Cut Permit Manual . 7South Windsor's Street
* * PERMIT TO BE �KEF� "k�" B ST'E SAT ALL TIMES.
Issued by
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Date Completed o .-
Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �k^ C9AWyWe/yu a 7i` K c Phone No: y�/-� - 5.�80
Address of Firm
Location f proposed ork � .{ ,
s� ,j 45f /
Describe fully nature of permit requested
Starting date Approx.time for completion -
Call Before You Dig No. 700 0_C-6 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash{)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• Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard_F-orms\Permits\Street-Excavation-Permit doc --