HomeMy WebLinkAboutCAble Street Cut Permits Hearthstone Dri Permit No. 2580 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD CATV-L�`,,4EARTHSTONE DR
Applicant Location
Name COX COMMUNICATION V'"I
Addr.. 801 PARKER ST. AP
T � 19 AND NEXT TO 52
06040 CT 06040 d L� f� Typ� 1 4�1$r CABLE
Phone (860)512-5000
"vw ry
Applicant agreesQ ' 1hp of� � dsor the amount of bond
required and to reinrie Tsodrt for any expenses
incurred by the To -fi1, epavcc" in connection with this
Permit and that ap wi abide by the rules and
regulations for perm"ts t ,
Cut Permit Manual . � South Windsor's Street
to
* * PER T Tb • � ,
AT ALL TIMES.
Issued by "T i tl er �--
-
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT.
FEE'$25.00
Name of Firm
Address of Firm Phone No.
L t' n of proposed work 6y�rP 2
Describe fully nature of permit requested s
Starting date Approx.time for completion
Call Before You Dig No. / gg9 6 /ale Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of
two copies of separate drawing South Windsor
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
()Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing
-Amt,-Dua,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:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc