HomeMy WebLinkAboutCAble Street Cut Permits 57 Jacques Lane Permit No. 2720 Town of South Windsor, CT
Date 06/21/1999 Street Excavation Permit
Expiration Date 06/20/2000
Descrip: CABLE TV SERVICE
Applicant
Location
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Name COX COMMUNICATIONS ' N �p61 JCQI,!ES LANE
Addr.. 801 PARKER ST. a` .
06040 CT 06040 a. df b , 'CABLE
Phone (860)512-5000
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Applicant agrees t�or fa..��th nd$or the amount of bond
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re u i red and to re i mtue � o th 1+ 1 r� r any expenses
incurred by the Town ,fir end p a ii5� k 1 o connection with this
permit and that app11 t a,�ide by the rules and
regulations for perms tq °,a. ��I1111 uth Windsor' s Street
Cut Permit Manual . -001
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* * PERMIT T0`' �°"BKE � � fE '� ,ALL TIMES.
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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 $25.00
Name of Firm Phone No.—
Address of Finn
Location of proposed work
Describe fully nature of permit requested 'A o
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
C-J Final Billing$
Ye z -._..
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.
ed: Date:
Sign
D.L.#:
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc