HomeMy WebLinkAboutCAble Street Cut Permits Left of House 6 Permit No. 2533
Date 02/16/1999 Town of South Windsor, CT
Street Excavation Permit .
Expiration Date 02/16/2000
Descrip: INSTALL 8' GROUND ROD � :,rREENWOOD DRIVE
Applicant 10
, < Location
Name COX COMMUNICATIONSOEUSE 66/BETWEEN 115 &
Addr. 801 PARKER ST.
06040 CT 06040 �
HYp vfy 4t�r CABLE
Phone (860)512-5000 ,
1. ry �
Applicant agrees to = nt h F
T of �tl dsor the amount of bond
required and to rei. ,
1rs� e °" ow ryf %puthArdsor w for any expenses
incurred by the Town, fo
� repxin connection with this
permit and that a
regulations for pp l � & �`� 64
per4, � �! �` abide by the rules and
Cut Permit Manual . �s;ct � �r� lw�'Of""'South Windsor's Street
� .
* PERMIT T`O
UTE AT ALL TIMES.
Issued by
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 $25.00
Name of Firm O Address of Firm Phone No. YiCd vr/-iza
'q!1. Q
Location of proposed wo
Describe fully nature of permit requested /
r0.1n p
Starting date
Cali Before You Dig No. Approx.time for completion
4� Traffic Services Control No.
Show sketch of proposed work or furnish To De filled out b Tow of Sou h Wi d r
two copies of separate drawing, n t n so
Indicate North Pavement Cu
Prop. size of cut
No.cuts
Amt.of Deposit$ 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
the Police De .and C.B.Y.D. 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 WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND gEGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: 4
Date: F l S
Title:
D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
.Standard Forms\Permits\Street Excavation Pennit.doc