HomeMy WebLinkAboutCAble Street Cut Permits Farm Brook Lane Fsermit No. 2535 Town of South Windsor, CT
Date 02/16/1999 Street Excavation Permit
Expiration Date 02/16/2000
Descrip; INSTALL 8' GROUND ROD .,F,,OR OAS --FARM BROOK LANE
Applicant „ Location
Name COX COMMUNICATIONS, ° z fl °SCOTT DR,
Addr. 801 PARKER ST. • � p' M
06040 CT 06040
Phone (860)512-5000
Yp �1' Wr CABLE
Applicant agrees tq 0&1Ah
of° �k t�rdsor the amount of bond
required and to rei nbarse 'tMe owh uth41 r�for any expenses
incurred by the Towh forpd �i epiEv in connection with this
�
permit and that app' i ,
� ' � wi` 1� abide by the rules and
regulations for perm�,,fttwSouth Windsor' s Street
Cut Permit Manual .
* */PE"RMIT T4�E1 "I" ,1TT ALL TIMES.
Issued by 1`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 $25.00
Name of Firm _l�E��l' �.a " Phone No.
0
Address of Firm
Location of proposed work _,P;P _ o j
j Describe fully nature of permit requested - Zz
Starting date Approx,time for completion
Cali Before You Dig No. /4Z9p D7W Traffic Services Control No.
Show sketch of proposed work or furnish To be.filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash{)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
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: Date: Z�G G p�
Title: D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation-Permit.doc