HomeMy WebLinkAboutCAble Street Cut Permits Fairview Drive Permit No.
Bate 2828
08/20/1599
Town of South Windsor, C1
Expiration Date 0{�0 Street Excavation Perr,.,it
Descrip : CABLE ROpAIR/�
AIRVIEW DR. FROM CLEARVIE►N TO l S 18.E BOTH
SIDES
Applicant
Name COX COMMUNICATIONS Location
Addr. 801 PARKER ST.
06040 CT 06040
Phone (860)512-5280 Type 4f Work CABLE
Applicant agrees to furnish the T
required and to reimto Own of
incurred b se 'the. Town of South 'Windsor the amount of
Y the Town for maintenance QSouthaWindsor for bond
Permit and that applicant, any expenses
is fa p work in connection with
regulations for permits as o rtl ilnadair�w ttz and, wi l l this
Cut Permit Manual , abide by the rules and
h® Town of South Windsor ' s Street
* * PERMIT Tp BE KEPT ON JOB SITE AT ALL Issued by TIMES.
Title X1,
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 $25.00
Name of Firm &Y,- CASE C Phone No.
Address of Firm
Location of proposed work G d'�Sr
Describe fully nature of permit requested -e Q
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control No._.
da
Show sketch of proposed work furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
M n Q pk Amt.of Deposit$ by
O Cash()Check#
Cut size after Perm. Patch
No. Cuts
C��r�`ew DR
Final Billing$
t Dus-PaWl
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:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc