HomeMy WebLinkAboutCAble Street Cut Permits 75 Good Hill Ro Permit No. 2703 Town of South Windsor, CT
Date 05/28/1999 Street Excavation Permit
Expiration Date 05/27/2000
Descrip: CABLE TV
Applicant Location
Name COX COMMUNICATIONS w
0p 5 00Q WILL ROAD
Addr. 801 PARKER ST.
06040 CT 06040sln
,0 VOn' "��Q A B L E
Phone (860)512-5000s,
Applicant agrees t� �urn� t� �the� "cif � ;C���+l�nd�;or the amount of .bond
required and to reimaure. Tov� jai= Sth t?1 �prpr any expenses
incurred by the Town ;for � ena �� � r rpaidk i connection with this
permit and that app i i c f r� and",W���I ��`a i de by the rules and
regulations for permisps� l �nf�f th Tfgwuth Windsor 's Street
Cut Permit Manual .
t
* PERMIT T :h, PT" 'T"BALL TIMES .
Issued by
--
Date Completed Inspected By /
w -IaI05
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
/ FEE $25.00
Name of Fir C� ( Phone No. 0' — S-a ey
Address of Firm O r car S lM�� .fps e
Location of proposed work 5 Goo 14
Describe fully nature of permit requested Q 7T
Starting date . 9cT Approx.time for completion / G
Call Before Yod Dig No._/99R,2:20,�9j::�,3 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
r No. cuts
i Amt. of Deposit$ by
()Cash ( )Check#
- — ��-
Cut size after Perm. Patch
61
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.
Signed,- - ��' Date: �; a
Title:
D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc