HomeMy WebLinkAboutCAble Street Cut Permits In front of 78 Permit No. 2615
Date 02/17/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8 ' GROUND RODF '-CATr ARSON WAY
Applicant :, Location
Name COX COMMUNICATION"
Add r. 801 PARKER ST. O F 78
06040 CT 06040 :' �, ..
Phone (860)512-5000 1;11
Yp ViF6r CABLE
App 1 i cant ag reed � h ��' of'r '���
required and to re i r�, dsor the amount of bond
e `orr► uth oar for an
incurred by the To ��° � �� Y expenses
permit and that app �A [ in connection with this
X ?,
regulations for ,., W++1� abide by the rules and
perrix �Cut Permit Manual . �#South Windsor's Street
` r ��
* * PER IT ALL TIMES.
Issued by
tie
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 �JZ s2jO
$T
Address of Firm ®D #o /2 -Phone No.
location of proposed work C"O i W ro-) f o. �
Describe fully nature of permit requested' t t 51- 61 C—f0%,K o Roo w.i C4fV
Starting date Approx.time for completion
Call Before You Dig-No 7 P Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ 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]OBSITE AT ALL TIMES
Standard Forms\Pe i _\Street Excavation Permitdnc