HomeMy WebLinkAboutCAble Street Cut Permits 12 Gail Lane Permit No. 2760 Town of South Windsor, CT
Date 07/09/1999 Street Excavation Permit
Expiration Date 07/08/2000
Descrip: CABLE SERVICE
Applicant
Location
Name COX COMMUNICATIONS ��1?r� AILLSANE
Addr.. 801 PARKER ST.
06040 CT 06040 ' ABLE
Phone (860)512-5000 r
Applicant agreeso'f Windsor the amount of bond
required and to reimku, sete; o th W7prFµfdr any expenses
incurred by the Town f`or amen e k ir"� �pai -OW, y connection ,with this
permit and that applicant 4 4 ide by the rules and
regulations for permit srsr,,,,u a_J i ned. i n thr T� g uth Windsor' s Street
Cut Permit Manual .
„
ERMIT KEST ti
ti �1� TE „ ALL TIMES.
41
Issued by .; t1e
Date Comp letl�sld _ Inspected By
a�
- �7W
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Q� Phone No.
Address of Firm
Location of proposed work WE Z N
Describe fully nature of permit requestedse
Starting date Approx.time for completion VIA 1AY,
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts,
' Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
-A Ift Due-Pa`-ee
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: re Date: 1
Title: /S--e��r---- D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc