HomeMy WebLinkAboutCAble Street Cut Permits 2 Clover Drive `Permit No. 2866 1
Date 09/17/1999 Town of South Windsor, CT
Expiration Date 09/16/2000 Street Excavation Permit
Descrip: CATV REPLACEMENT
Applicant
Name COX COMMUNICATIONS Location
Addr. 801 PARKER ST. 0002 CLOVER DRIVE
06040 CT 06040
Phone (860)w12-5280 Type of Work CABLE
Applicant agrees to furnish the Town of Souuth Windsor th
required and to reimburse the Town of South Windsor for any expenses
incurred by the Town for maintenance or repair work in connection amount of bond
Permit and that applicant is familiar with and will abide by then with this
regulations for permits as outlined its the Town of South Windsor'su and
Cut Permit Manual .
Street
* PERMIT TO BE ,IKEPT ON Joe SITE AT ALL TIMES.
Issued by
Title
--
Date Completed
`--- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
_ TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
_ FEE $25.00
Name of FirmcX cccUe Phone No. � _bra
Address of Firm
Location of proposed work of CZarmor r•
Describe fully nature of permit requested CATV
Starting date Approx.time for completion
Call Before You ig No.11?9f.3 80.770� Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two.copies of separate drawing
Pavementcut
Indicate North Prop.size of cut
LL No.cuts
we"r
a Amt.of Deposit$ by
{)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 WINDSORIS STREET CUT PERMIT MANUAL.
Signed:�:E Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard-Forms\Permits\Steet_e.ccavation.P_ermit.doc—