HomeMy WebLinkAboutCAble Street Cut Permits 46 Farm Brook L Permit No.. 2622 Town of South Windsor, CT
Date 03/05/1999 Street Excavation Permit
Expiration Date 03/04/2000
Descrip: HOUSE CONNECTION
Applicant Locat
ion
Name COX COMMUNICATIONS k( 048 fiAR�I a`R0OK LANE
Add r. 801 PARKER ST. � a
06040 CT 06040 wk SABLE
Phone (860)512-5000
Applicant agrees tofr tlbiWindor the amount of bond
required and to re i mbure ;TdvY1 h ► 7r4r fir any expenses
incurred by the Town fa connection with this
permit and that app 1 i canta ` °a °> �.. d 1 .aabi de by the rules and
regulations for permiis�.� s'° �D� t o � uth Windsor's Street
Cut Permit Manual . �
.a '
* -I( PERMIT TO ` �
$ IC �� ALL TIMES.
Issued by l � Tv I e
Date Completed
- a Inspected By _L
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �> Phone No.—
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. 00 d Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
�1! Final Billing $
Ix lsF 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.
Sign Date: v C
Title: D.L.#
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc