HomeMy WebLinkAboutCAble Street Cut Permits 16 Chapin Stree Permit No. 2769 t
Town of South Windsor, CT
Date 07/15/1999 Street Excavation Permit
Expiration Date 07/14/2000
Descrip: CATV
Applicant
Location
Name COX COMMUNICATIONS
041 HAS �� STREET
Addr. 801 PARKER ST.
06040 CT 06040 ` 94)4`5of [ C ,ABLE
Phone (860)512-5000
Applicant agrees to fu�� nth� T ; � � or the amount of bond
� � Wtn
required and to re i mb a jo�� 9►� �t th ►o' ' fir any expenses
incurred by the Town for 10�enVt paid connection with this
permit and that applicant bide by the rules and
regulations for permit � i i need i n t auth Windsor's Street
Cut Permit Manual .
;jdPERMIT TO 8E KEPT„' �? ET ALL TIMESIssued byDate Compl Inspected By
p' `k
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 COX Cal Phone No. $CO' 52— ,2$d
Address of Firm o/ er S a 4es r
Location of proposed work /G g�oia r
Describe fully nature of permit requested
Starting date �0 9 Approx.time for completion 125
Cali Before You Dig No. 0 13-7 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
�6 Amt.of Deposit$ by
iy r
{)Cash{)Check#
r
Cut size after Perm. Patch
.p�
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: �5 AF cl _
Title: D.L.#•
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard Forms\Permits\StreetExcavationPermit.d4G._ .. ..-