HomeMy WebLinkAboutCAble Street Cut Permits 31 Clearview Dr Q
Permit No. 3088 Town of South Windsor, CT
Date 04/ 19/2001 Nl� Street Excavation Permit
Expiration Date 04/ 19/2002
Descrip
Applicant Location
Name COX COMMUNICATIONS r ,
Addr. 801 PARKER ST . � �
06040 CT 06040
Twee ► 4 o lC. CABLE
Phone ( 860 )432-5211
Applicant agrees to ,; ut�th:g4tl�Z� 1 owr� fO f. South .W i n;datior the amount of bond
required and to reimdu°rse :thy' Town of 5ruth WThd'sor for any expenses
incurred by the Town `fi t t e err � air k ar,k� i o connection with this
permit and that app 1 i aat farr� �^ i� ad w 11 abide by the rules and
regulations for permsts` 'as .' r+ `I, r ! ±�nrTparn; oF South Windsor' s Street
Cut Permit Manual .
PERMI O BE 'KEPT O'N J68'' SITE AT ALL TIMES. * �
Issued by
- - " - ------- - Ti t i e
Date Comp13 eted _ O/ .�/o Z _ Inspected By _
i
µ APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR ---=-
PUBLIC WORKS DEPART MENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm 6 (3 Phone No.
Address of Firm
Location of proposed work l e.CU a7 dam`.rxT
Describe fully nature of permit requested .i E E
Starting date_ E -g O - C)"1 Approx.time for completion
Call Before You Dig No,26ryl I I-n(2 RL4 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement G��
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
�c ()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. k _ Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
Mass: Ph: 888-344-7233
Mass ID#17930 Fax 781-721-0047
DIG SAFE NUMBER 2001
Conn: Ph: 800-922-4455 = DIG SAFE CLEARS ON AIL AT 7:00 AM
Contractor#1167
Date /01 EMAIL CITY S
G,jI�vASy�--
STREET ADDRESS
CROSS STREET
CHANGE IF DIFFERENT: WORK: Installing CAN DEPTH: 24" AREA PREMARKED ?: YES
Utilites Notified: CL CrLj&h Co)c ibn� e SN
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