HomeMy WebLinkAboutCAble Street Cut Permits 60 and 70 Judge Permit No. 2534
Date 02/16/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 02/16/2000
Descrip: INSTALL 8 ' GROUND ROD � UDGE LANE
Applicant
r , 4, . Location
Name COX COMMUNICATION e,,
Addr. 801 PARKER ST. �� y tt �� 60&70 IN FRONT OF
06040 CT 06040 _ yp Q ?, Work CABLE
Phone (860)512 - '-5Q0 Q
f r'a
Applicant agree of
required and to reimurs e Iowa puth + sflydsor the amount of bond
incurred by the Towri o` 7F .i �Isor for any expenses
permit and that app � 7I .
ep� wO -k in connection with this
regulations for permiir ►yi" 14 abide by the rules and
Cut Permit Manual .
�' � T South Windsor's Street
A
* * PERMIT TO BE KEPT 'JOB SITm . AT ALL TIMES.
Issued by
It
le z
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 $25.00
Name of Firm rJroYr �d ��
Address of Firm Phone No.
Location of proposed work ,/�_ /" 27 , ,
o f/ .tiesra�
Describe fully nature of permit requested .r
d r
Starting date Approx.time for completion Call Before You Dig No. l 44� 7ctd oof�/ Traffic Services Control No.
Show sketch of proposed work or furnish To be Lille out b Town of Sou h Windsor
two copies of separate drawing d y t
Indicate North Pavement Cut
Prop. size of cut
No.cuts
Amt.of Deposit$ 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 by
the Police Dept,and C.B.Y.D. date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOU
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MA NT"OF BOND REQUIRED-AND TO REIMBURSE THE TOWN.OF
PERMIT AND THAT I A
INTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
AND 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 Form0ermitAStreet Excavation Permit.doc