HomeMy WebLinkAboutCAble Street Cut Permits 40 Chase Farm R 2844 _
Date 08/27/1999 `town of South Windsor, CT
Expiration Gate 08/26/2Ufl0 Street Excavation Permit
Descrip: CABLE SERVICE
Applicant
Name COX COMMUNICATIONS Location
Addr. 801 PARKER S'T. 0040 CHASE FARM ROAD
06040 CT 06040
Phone ( 860)512-5280 Type of Work CABLE
Applicant agrees tcs furnish the Town of South Windsor
required and to reimburse the Town of South Windsor for any ex
es
incurred by the Town for maintenance or repair the amount of bond
Permit and that applicant is fenance with and will abide b `penswi
work �n connection with this
regulations for permits as out3iragd in the Town of Y he rules and
Cut Permit Manual . South Windsor 's Street
* *: PERMIT TO BE KEPT' ON JOB SITE AT ALL TIMES.
Issued by
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Date Completed , - ----=__ �_-'-
Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm _ Phone No.
Address of Firm
Location of proposed work rm
Describe fully nature of permit requested Q
Starting.date `"3'it L Y-7Approx.time for completion d1
Call Before You Dig No. 1322.1 cd Traffic Services Control No.
Show sketch of proposed work or furnish To o be filled out by Town of South Windsor
two copies of separate drawing
Pavement Gut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash O Check
Cut size after Perm. Patch
No. Cuts
�QCj 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 3OBSITE AT ALL TIMES