HomeMy WebLinkAboutCAble Street Cut Permits 153 Gail Lane Permit No. 2675 Town of South Windsor, CT
Date 05/05/1999 Street Excavation Permit
Expiration Date 05/04/2000
Descrip: CABLE SERVICE
ApplicantE � ° Location
.;
Name COX COMMUNICATIONS
Addr. 801 PARKER ST. 0I� ANE
06040 CT 06040
Phone (860)512-5000 �dmf `CABLE
oe
Applicant agrees tor �shi th ndor the amount of bond
required and to re i mkzu $e` .;Yo
� ktth �tc �rQr any expenses
incurred by the Town �frrrr 4�4
rrena aik ith connection with this
permit and that appi igat.�I f �� � ��e,an yy� �i de by the rules and
regulations for permi s. ,4 ou oath Windsor's Street
�
Cut Permit Manual .
* * PERMIT TC a;,SE � SF E qTv ALL TIMES.
Issued by �R�A
TM. Ti°t��
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 $25.00
Name of Firm a Phone No. IS-0 si y"
Address of Firm Al er S
Location of proposed work / Ga4I L L rJ
Describe fully nature of permit requested C'A.sle TO -_a4Uc-Q
Starting date S Approx.time for completion
Call Before You Dig No. ® / Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
O Final Billing$
n� Amt. Due Payee$
�l 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::]E Date: i
U
Title: _ D.L.#:
PERMIT SHALL BE KEPT ON)OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc