HomeMy WebLinkAboutCAble Street Cut Permits Between 19 and Permit No. 2545 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8.' GROUND ROD BUR `CA`rV `--QODY CIRCLE
Applicant
Location
Name COX COMMUNICATIONS T, EIN&35, 95&105
Addr. 801 PARKER ST. `
06040 CT 06040 Type of ._4(6rk CABLE
Phone (860)512-5000 `
z
Applicant agrees f �h �' of 1�tlr dsor the amount of bond
required and to rei ,ir° time 1'oi � x� uth , '
incurred by the Tow� `or � dorf4r any expenses
reP 1t� Q , in connection with this
permit and that app1lan :.;�( � � ' abide by the rules and
re g u 1 a t i o n s for permi,44South Windsor's Street
Cut Permit Manual .
* * PERMIT TOoyf
TENT ALL TIMES.
Issued by
itle
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 $25.00
Name of Firm L Z5L y/ Phone No. �Q
Address.of Firm
Location of proposed work 7 y
Describe fully nature of permit requested
Starting date Approx.time for completion
- Call Before You Dig No. ,l D1 D?,JG D2U.?Traffic Services Control No.
Show sketch of proposed work or furnish To be filled.out by Town of South Windsor
two copies of separate drawing
Pavement Cut \
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash O 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::a,, Date:���/ !
Title: 4n, ZZ, D.L.#•
PERMIT SHALL BE KEPT ON]OBSrrE AT ALL TIMES
Standard FormsiPem \StreetExca�cation.Pennitdoc—__-- -----.- --- - -