HomeMy WebLinkAboutCAble Street Cut Permits Chapel at St Ma Permit No. 2621
Date 03/05/ 621 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 03/04/2000
D,escrip: ROAD BORE OR ROAD CUT-INZ4"kQ 1`"J�
CONDUIT
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Applicant .
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' Location
Name COX COMMUNICATIONS
Addr. 801 PARKER ST. ^ MARC CIRCLE
06040 CT 06040 � ,
T ,pe
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ABLE
Pone (860)512-5000 o
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Applicant agrees O.. Lf`, �
requfired and to reim r4 To k f S or the amount of bond
`' ' h W r �f r any expenses
incurred by the Town � .
a i 'i�, connection with this
permit and that app 1 i 4nt ° aar �
regulations 1 at i ons for 1;.` b i de by the rules and
permi t� ° a's o "
:Cut Permit Manual . " ��, �t 5 iuth Windsor's Street
* PERMIT TO BE'
IT
77. AT ALL TIMES.
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Issued by i t, � •,` __o„T
TItl e
date Comp eted 1 to
Inspected By
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APPLICATION
OWON OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm-cc''
Location of proposed work- C E i S7 AC C 1 'P
Describe fu�nfature opermit� �requeste ('Z�' C} v1
Starting date ►►�, l.*f'� Approx.time for completion pAy
Call before you dig no. I { I O To t a-; Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate N h p qo3q
Prop. size of cut
dNo.cuts
A��f �� 1 Amt. of Deposit$ by
1 () Cash (1 Check#
I
r , o � �-- Cut size after Perm. Patch
+l G No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R IIMBURSE 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.
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PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
o CLI Damgd Drop
N Dama OD Cable?,' rm t
Date I / ! Technician Name
Town Technician Title `sY
Address S r MA C Su ervlsor Approval Customer Information
Name Home Phone# _
Account# Business
Phone# y..,. �.
Construction-Intormation
Nearest Cross Street t^f s
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E+ Length of Drop t-IO�C� i ' f� !
� Cable Type TempiQrpp in Plate`
Sidewalk Bore tj
TO Number..____
Driveway Bore _ Last Three On`
1.4
Road Bore
Is there a pact
o Riser Pole Number 3
N Damaged By -• ..
r big Safe n otdied
o Phone'Number
Tap: Leak-
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