HomeMy WebLinkAboutCAble Street Cut Permits 80 Horizon Circ a--
Permit No. 2674 Town of South Windsor, CT
Date 05/04/1999 Street Excavation Permit
Expiration Date 05/03/2000
Descrip: CABLE TV
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Applicant Location
Name COX COMMUNICATIONS DB�; HpRIZ'�1N CIRCLE
Addr. 801 PARKER ST. A
06040 CT 06040 + `x fldt"k'CABLE
Phone (860)512-5000
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Applicant agrees tb,',1=ur thepn � t `yy ndor the amount of bond
required and to reimburse 41 � ,:fio�! 'ofoth W7hd4r, for any expenses
incurred by the Town 1 brnti ntenanp ot~ ' pa i rk ,i connection with this
permit and that app 1 i ceilbtf f "# r W� and i a i de by the rules and
regulations for permitsll ,ofq�uth Windsor's Street
Cut Permit Manual .
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* * PERMIT TO B'i= K R3 C�`N:- ,68, SITE ,AT ,.,ALL TIMES.
Issued by T�t�l
Date Completed Inspected By
S/G /L(o
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Goi, C Phone No. �ckll �Vo?
Address of Firm )
Location of proposed Work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
d 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: [ `
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc