HomeMy WebLinkAboutCAble Street Cut Permits 30 Fox Hill Roa Permit No. 2628 Town of South Windsor, CT
Date 03/05/1999 Street Excavation Permit
Expiration Date 03/04/2000
Descrip: HOUSE CONNECTION .w
Applicants
Location
MEi 1
Name COX COMMUNICATIONS � � ' R ODS7
Addr.. 801 PARKER ST LL ROAD
06040 CT 06040
Phone (860)512-5000 � � _. Type CABLE
Applicant agrees too ur t bf 5 'Wi Sor the amount of bond
required and to re i mbusa ,;`T�wnh W � qrr any expenses
incurred by the Town Fc t t f^ ,epa1r �t connection with this
Permit and that app 1 it � `s bide b the rules and
regulations for �.�, Y
permits�� s ' �n otiuth Windsor's Street
Cut Permit Manual .
* * PERMIT TO Kk#,,p 7M 408 AT" ALL TIMES.
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Issued by �T- -
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Date Complete Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 6
Phone No.
Address of Firm
Location of proposed work S0 Eig, Wl
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. 006 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
P� 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 WIN SOR'S STREET CUT PERMIT MANUAL.
Signe Date:
Title:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc