HomeMy WebLinkAboutCAble Street Cut Permits 34 Country View z
Permit No. 2721 Town of South Windsor, CT
Date 06/21 /1999 Street Excavation Permit
Expiration Date 06/20/2000
Descrip: CABLE TV SERVICE
Applicant Location
Name COX COMMUNICATIONS 003*,�C6UN'#Y VIEW DRI
Addr. 801 PARKER ST. _ „
06040 CT 06040 , Te :,f1f1CABLE
Phone (860)512-5000
Applicant agrees :W1 ndtor the amount of bond
required and to re i mbuse Tox ytth Ire or any expenses
incurred by the Town for ra.a tend o �pai t� ,in connection with this
permit and that applic 'nt f r Wi g tl abide by the rules and
regulations for permits e ; r limed n ties � f ,South Windsor' s Street
Cut Permit Manual.
* * ERMIT T0' BE K I .E ATALL TIMES.
Issued by Ti'tl`e ,
Date Comp l e ed
Inspected By
J R
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm CL Phone No. �a J a�
Address of Firm
Location of proposed work U
Describe fully nature of permit requested
Starting date Approx.time for completion 4
Call Before You Dig No. 1 Traffic Services Control No.
Show sketch of proposed work or.furnish To be filled-out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
l
Cut size after Perm. Patch
No. Cuts
Q Final Billing$
l� 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.
Signe - Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Pecmits\5treet.Excavabon Permit.doc _ _