HomeMy WebLinkAboutCAble Street Cut Permits 75 Governors Hi Date
®S/2i/ 1998 Street Excavation Permit
Expiration Date 08/26/2000
Descri.p: ROAD BORE OR CUT
Applicant Location
Name COX COMMUNICATIONS 0075 GOVERNORS HIGHWA
Addr. 801 PARKER ST .
06040 CT QC>040 Type of Work CABLE
Phone (860)512-5280
Applicant agrees to furnish 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 applicant is 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 .
PERMIT TO. BE KEPT ON JOB SITE AT ALL TIMES.
Title
Issued by _µ
Date Completed ; Inspected By
i
y
APPLICATION FOR STREET
TOWN OF SOUTH WIN EXCAVATION PERMIT
PUBLIC WORKS DEPARTME T
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOlk CT
.FEE $25.00
Name of Firm :C) CW
Address of Firm Phone No.
Location of proposed work
cxl
Describe fully nature of permit requested
Q
Starting date
Call Before You Dig No. Approx.time for completion
TrafFic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be Ned out by Town of South Windsor
Indicate North Pavement ut
Prop. size of cut
No.cuts
Amt.of Deposit$ by
OCash OCheck#
"�-- Cut size after Perm. Patch
No. Cuts
�vl a Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting
the Police De t.and C.B:Y.D. by date
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
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. WITH THIS
Signed:
Title: Date:
D.L.#•
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Fonns\Permits\Street Excavation Permit.doc