HomeMy WebLinkAboutCAble Street Cut Permits 24 Judge Lane 2867 Town of South Windsor, CT
Date 09,%17/ 1999
' t No. Street Excavation Permit
Date
Expiration Date 09/16/2000
Descrip: CATV REPLACEMENT
Location
Applicant
Name COX COMMUNICATIONS 0024 Judge Lane
Addr . 801 PARKER ST . Type of Work CABLE
06040 CT 06040
Phone �860 )512-5280
Applicant agrees to furnish 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
ith w
permit and that applicant s _ f mi, liar wthe ToWnorla0utajWindsor' sules Streetd
regulations for permits as
Cut Permit Manual .
* *, PERMIT 1'Q BE KEPT ON JOB SITE AT ALL TIMES. * �
` Title
Issued by
Date Completed
Inspected B y ___
_ A(d7
APPLICATION FOR
STREET EXCAVATION .PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Lo
Address of Firm r err He ties r Phone No.
Location of proposed work
Describe fully nature of permit requested ffTy r� ce•,,a,n
Starting date 9'
Call Before You Dig No. Approx.time for completion
Traffic Services Control No.
Show sketch.of proposed work or furnish
two copies of separate drawing To be fill out by Town of South Windcnr
Indicate North PavementQg
Prop.size of cut
,( No.cuts
Amt.of Deposit$ by
{}Cash O Check#
Cut size after Perm. Patch
2 c� No. Cuts
Final Billing
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting
the Police I)pnt 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 TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CO
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN T
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. CONNECTION WITH THIS
HE
Signed:
Date.'
Title:
PERMIT SHALL BE KEPT ON.306SITE AT ALL TIMES -
Standard Forms\Permits\Street Excavation Permit.doc