HomeMy WebLinkAboutCAble Street Cut Permits Between 22 and Permit No. 2614 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD F,,OW 'CAT --, ARSON WAY
Applicant
Location
Name . COX COMMUNICATION$ � � � �
B T EN� U30, 37&45
Addr. 801 PARKER ST.
06040 CT 06040Type cvftor CABLE
Phone (860)512-5000 0.
Applicant agrees $ kfr' h hfi of4 w hdsor the amount of bond
required and to rei�nb+ur*' e Tom ' uth or for any expenses
incurred by the Towso >�� rep " Svc in connection with this
permit and that ;app in , �. is "� ,a ^� w j�l abide by the rules and
regulations for per m,1 it' 9South Windsor's Street
Cut Permit Manual .
i
* * PERMI 7 3 KEP � UO� T �,AT ALL TIMES.
Issued by yam- title
-
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN MALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. 1 V
Address of Firm 4a
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion -
Call Before You Dig Not -d 60-i7 SG, Traffic Services Control No.
Show sketch of proposed witrk or furnish To be filled out by Town ofi"South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ - 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: r Date: z/l.0Cf9
Title• D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Form \Pe i \Street Excavation rmitdoc�� ---