HomeMy WebLinkAboutCAble Street Cut Permits 69 Cambridge Dr Permit- iro. 3061 Town of South Windsor, C (
Date 01 / 16/2001 Street Excavation Permit
Expiration Date 01/16/2002
Descrip:
Applicant Location
Name COX COMMUNICATIONS ,r 9 CAM$RIDOE DRIVE
Addr. 801 PARKER ST.
06040 CT 06040 T", a 'of Work CABLE
Phone (860)432-5211
Applicant agrees tt� furtr7 h tie Tolkrrt`"of �cauth' Wi",ndsor the amount of bond
required and to reimbur the kT,z50►n �-1" 'South';- rndsor; for any expenses
incurred by the To► n x fia,inte nZ 0r repel r�" v rkEin connection with this
permit and that apgl ca s is ttah w111 abide by the rules and
regulations for �''"
g pens but rnet� °7n tie Trwrn �of 'South Windsor 's Street
Cut Permit Manual .
* * PERMIT T0" BE ryKP1` t N' Jt3B SITE AT ALL TIMES.
Issued by �. �G-P�A Ti"t1e -oS�iC"'jCi���1D/�
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 $25.00
Name of Firm COK Phone No._Y(00 - 21,70
Address of Firm R
Location of proposed work %9 CAH f (&.40& T
Describe fully nature of permit requested e-AAXG
Starting date 1- --01 Approx.time for completion I ,�
Call Before You Dig No. - Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
D �� ()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 R PAIR Wr)nv*RI ^ -:TION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY TWC "" - OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
n�
Signed: �r
Title:—C" a,024
PERMIT SHALL BE KEPT ON]OBSITE AT ALL
TIMES
Standard Forms\Permits\Street Excavation Permit.doc
Mass: Ph: 888-344-7233
�+ MrIss IN 17930 Fax 781-721-0047
' DIG SAFE NUMBER 20016 -;?�6
Conn: Ph: 800-9224455 DIG SAFE CLEARS ON AT 7:00 AM
Contractor#1167
Date /01 EMAIL MUNICIPALITY
STREET ADDRESS & DESCRIPTION
(Apartments&Condo's must list name of complex•Or list the number of feet from the cross at as well as N,E,S or W) 69
,v tsU� 6461 !� P y
CROSS STREET t j l LL&--YL 2,o AREA MARKED ? YES
WORK: InstaNing CATV Utilities Notified: ry-4yO_ y� ,�E;�_ &-/ _C _
DEPTH: '
v
41
p
elCTI'�
/ 1�-c
D,
L
e