HomeMy WebLinkAboutCAble Street Cut Permits 153 Krawski Dri Permit No. 2716 Town of South Windsor, CT
Date 06/15/1999 Street Excavation Permit
Expiration Date 06/14/2000
Descrip: CABLE TV SERVICE
Applicant ` Location
Name COX COMMUNICATIONS
�� a � 5RA� DRIVE
Addr. 801 PARKER ST f
06040 CT 06040
Phone (860)512-5000
Y of �Vsrk CABLE
Applicant agrees touri' k� th T of Sii�u dor the amount of bond
required and to reimtu� e �e Tc� i � Wth 1lndr or any expenses
incurred by the Town for a< en,ap,; vor �i�pai � �� ih connection with this
permit and that app 1 i ca'i^t � n w i de by the rules and
regulations for permits ' s u lined n tip` + w ef, S4uth Windsor's Street
Cut Permit Manual .
4etd
PERMIT T B'E *KEAITY ALL TIMES.
Issued byDate `Comp Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. �`p� S-R
Address of Firm Oct
Location of proposed twork
Describe fully nature of permit requested C- 4,
Starting date i Approx.time for completion_ OVJ Un vc Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
1!�3 No.cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
\ j No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
the Police De t. and C.B.Y.D.
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 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: Date: U l�
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc