HomeMy WebLinkAboutCAble Street Cut Permits 12 and 24 Jonat Permit No. 2584 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD "� NATHAN LN
Applicant
.§ Location
Name COX COMMUNICATIONS r s BTM � 24
Addr. 801 PARKER ST.
NQ 4` yP o �;M 1 br CABLE
06040 CT 06040
Phone (860)512-5000 x,
Applicant agree fhT of` Ih i dsor the amount of bond
required and to re i °b�r tM�e Toni uth
�Jsor for any expenses
incurred b the Tow fora - "
y �� tl � ep2� h , vdk� in connection with this
perm i t and that app 1, ra s w.i f1 abi de by the rules and
regulations for perr�it-i �Ww►t ofe lSouth Windsor's Street
Cut Permit Manual . s
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s,
* * PERMIT Tb- B 'KEP AT ALL TIMES.
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Issued by ��G"
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 $25.00
Name of Firm
Address of Firm Phone No. (�
Location of proposed work ¢ .
Describe fully nature of permit requested
' o
Starting date
Call Before You Dig No. /95' 0.4 g Approx.time for completion
Traffic Services Control No.
Show sketch of proposed-work or furnish To be filled out b Town of South
two copies of separate drawing Windsor
Indicate North Pavement gut
Prop
.size p of cut
No.cuts
Amt.of Deposit$ 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 b
the Police De .and C.B.Y.D. y date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TOREIMBURSE 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: Z
Date:
Title:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc