HomeMy WebLinkAboutCAble Street Cut Permits 21 Jonathan Lan Permit No. 2627
Date 03/05/ 627 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 03/04/2000
Descri p: HOUSE CONNECTION
Applicant
Location
Name COX COMMUNICATIONS " �°
Addr, 801 PARKER ST. ', , ��� �', k 0Q°2 nn Lane
s � ,
06040 CT 06040 � °� � , W `
Type ` ot�fcABLE
Phone (660)512-5000 �
a r{ 1
Applicant agrees tf* 6' 0 bf S6, 1 li d or the amount of bond
required and to reimbuse��® 'Townsf ��h WSbr or any expenses
incurred by the Town air work ° connection with this
permit and that app l iaxtt ,#,8
' a� a ► bide by the rules and
regulations for permits ° s
Cut Permit Manual . � ,b 'South Windsor's Street
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�:.
i* PERMIT O Crp ,��� S,I"T ���, ALL TIMES.
Issued by l'tt
Date
A
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Comple ed > Inspected 8y
APPLICATION FOR STREET EXCAVATION PERMIT
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TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm
Address of Firm Phone-No.
Location of proposed work
Describe fully nature of permit requested
Starting date
Call Before You Dig No. V pC1 Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out b Town of South Windsor
Indicate North Pavement Cut
Prop. size of cut
No. cuts
Amt.of Deposit$ b
Y
()Cash ()Check#
Cut size after Perm. Patch
} No. Cuts
Final Billing $
- Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting �.P�
the Police Dent and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TO
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH
PERMIT AND THA I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED N THE
OF
TOWN 0 OUTH NDSOR'S STREET CUT PERMIT MANUAL. H THIS
Signe _
Date:
Title: <
D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc