HomeMy WebLinkAboutCAble Street Cut Permits 81 Juniper Lane Permit No. 2908Town of South Windsor , C1
Date 01 / 18/2000 Street Excavation Permit
Expiration Date 01/17/2001
Descrip:
Applicant Location
Name COX COMMUNICATIONS
Addr. 801 PARKER ST. � 0 $1 NI
PER LANE
06040 CT 06040 T of Work "CABLE
Phone (860)512-5280
Applicant agrees to ur 1sh the tT o 0Ut Wind6or the amount of band
required and to reimdurs� '=�a . � th War for any expenses
incurred by the Town 'for +a��1rt_ na ► Qpai � iur} ih connection with this
permit and that applipant s fa r i14,, abide by the rules and
regulations for permisui0 South Windsor 's Street
Cut Permit Manual .
* P� RMIT T0 ` .":ALL TIMES. * �
Issued by
Date Comp te4 _-- — Inspected 0y `-
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
_ Name of Firm
Address of Firm p Phone No.
Location of proposed work
Describe fully nature of perm• requested A.J
r _ S�2
Starting date
Call Before You Dig o. p U 1 6-.7 ApiM time for comp etion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be tilled out 6y.Town of South Wind r
Indicate North :}.,`. Pavemen n►t
Prop.size of cut
,. No.cuts
Amt.of Deposit$ - by
1
< O Cash(.)Check#
Cut size after.Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee
Amt. Due Town
Applicant is responsible for contacting
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 TOWN
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
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. AS OUTLINED IN THE
Signed:
Date:
Title: fin yC�� c��,e G���n
D.L.#:
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Pennits\Street Excavation Permit.doc