HomeMy WebLinkAboutCAble Street Cut Permits 80 Chase Farm R 09/01/1999
Town of South
Expiration Date 08 Street Excavation
CT
Descrip: CATV /31/2000 Excavation Permit
REPLACEMENT
APP l i caolt
Name Addr COX COMMUNICATIONS location
.
801 PARKER ST.
06040 CT 06040 0080 CHASE FARM ROAD
Phone ( 860)512-5280
Type of Work CABLE
Applicant agrees required to fi�rt1 sh. the
Incurred and to reimburse th flown of South Windsor
by the Town for Town of South the amount of
permi t and that maintenance Windsor for,
bond
requlati applicant is `amnd or repair abide
this
ons for permits dr with work
Cut Permit Manual , as outl and w1�il with is
+ the Town of South e by the} rules and
Windsor s Street
* * ; PERMIT TO BE #DEFT
Issue, by ON SOB SITE AT
-'---- __ X, ,; ALL TIMES. ,
Date Complete _ - _ - -- Title ~
Inspected By --_
K,
a�5�3
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
-TOWN HALL
- 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
/ FEE $25.00
Name of Firm Phone
Address of Firm osed work r Nc as
Location of prop _ o C asP rss, � No.
Describe fully nature of permit requested v d'es�kcc .�•.
Starting date ., -22 Approx.time for completion
Call Before You Dig Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
C' r Amt.of Deposit$ by
(}Cash{)Check#
Cut size after Perm. Patch
No. Cuts
2 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\Permits\Street.F Fxcavation-Permit.doc.._ ._---