HomeMy WebLinkAboutCAble Street Cut Permits 5 Country View Permit No. 2626 Town of South Windsor, CT
Date 03/05/1999 Street Excavation Permit
Expiration Date 03/04/2000
Descrip: HOUSE CONNECTION
Applicant Location
Name COX COMMUNICATIONS 10�5 CsDUNTR ! VIEW DRI
Addr. 801 PARKER ST.
06040 CT 06040 Typ'eo► t SABLE
Phone (860)512-5000
Applicant agrees to 'u,r� F� tt � a bf Sc , Vi-nd$or the amount of bond
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required and to reimburse. Town Wi gi h W����r--for any expenses
incurred by the Town �fvo 'w a r '. sr� connection with this
permit and that app 1 ate` :ail " g rd� 4e4"1 T `wetb i de by the rules and
regulations for permit's°sus 7.6t�,sz fiuth Windsor 's Street
Cut Permit Manual .
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*� * �ERMIT TO 1CLPT "bN. 3E $ ALL TIMES.
Issued by t lne 'y -
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Date Comple�ed / Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 2 Phone No.
Address of Firm
Location of proposed work q UZ
Describe fully nature of permit requested
Starting date _ Approx.time for completion
Call Before You Dig No. 15 19 160O Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash()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 Vf NDSOR'S STREET CUT PERMIT MANUAL.
Signed. _ Date: 3z�� 9
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc