HomeMy WebLinkAboutCAble Street Cut Permits 35 Gail Lane Permit No. 2631 Town of South Windsor, CT
Date 03/05/1999 Street Excavation Permit
Expiration Date 03/04/2000
Descrip: HOUSE CONNECTION
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Applicant Location
Name COX COMMUNICATIONS , w , ; 00'85 A,IL rLANE
Addr. 801 PARKER ST.
06040 CT 06040 Type r *` �r` c 'CABLE
Phone (860)512-5000 .; z
Applicant agrees to 'fdr
the T' of Stith Wirrdtor the amount of bond
required and to reimlre a Town Widor fpr any expenses
incurred by the Town fc � `� ewt � pai r, p:r �i connection with thi s
TIT
permit and that appl i ca, t �i a ►�#r' i at wYi. a l"fxpabi de by the rules and
regulations for permit�s�,,� s 1"c► ta . # aS�uth Windsor's Street
Cut Permit Manual . ;
* * ERMIT TO 0# I ' AT' ALL TIMES.
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Issued by i ..Tile
Date Comple�ed/ o Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm eo-L Phone No.
Address of Firm
Location of proposed work GA:L L—ry
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. D Traffic Services Control No.
Show sketch of proposed wor o To be filled out by Town of South Windsor
two copies of separate awwin
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
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.
CSigned: Date: L�Al S
Title: D.L.#:
PERMIT SHALL BE KEPT ON IOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc