HomeMy WebLinkAboutCAble Street Cut Permits 130 Cody Circle y
Permit No. 2638
Date 03/24/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 03/23/2000
Descrip: HOUSE SERVICE CATV
Applicant
a Location
Name COX COMMUNICATIONS
Addr. 801 PARKER ST. � � D RCLE
06040 CT 06040p '� `
Phone (860)512-5000 �Ypei< 'ioic SABLE
Applicant agrees thou t s� �f S ''
required and to reimbr' se MO$or the amount of bond
incurred by the Town f�,�� ��'� To�vr�� � h � ����" any expenses
permi t and that a 1 ia � ai ' ��� connection with this
pp a �a1�e i de b regulations for perms tss' Y the rules and
Cut Permit Manual 8o � uth Windsor's Street
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* * PERMIT TO3 � ; � �
74T,,�ALL TIMES.
Issued by AA
ar .rT tal e' 3 ET
Date Completed fo Inspected By
3�s
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 2 e Phone No.
Address of Firm SO k VARK(ir , T
Location of proposed work Go CEav o7cR
Describe fully nature of permit requested LjduspC .
Starting date 2 2 Approx.time for completion 10 ows
Call Before You Dig No. I Mn 136 132 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
LAB r Amt. of Deposit$ by
O Cash O Check#
Sell) Cutsize after Perm. Patch
Q�co 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.
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Signed: Date: ,3 �Y
Title: D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc