HomeMy WebLinkAboutCAble Street Cut Permits 205 Natsisky Fa Per6iit No.
2741 Town of South Windsor, CT
Date 06/29/1999
Street Excavation Permit
Expiration Date 06/28/2000
Descrip CABLE TV SERVICES
Applicant '11 �
� Location
Name COX COMMUNICATIONS
Add r. 801 PARKER ST. � 14,4T$1,SKY FARM RO
06040 CT 06040
Phone (860)512-5000 � f "CABLE
Applicant agrees tows T o
required and to reim
tlador the amount of bond
incurred by the Town `for aten
" huh Wcr any expenses
t"epa� *bt JO connection with this
permit and thfir
at app 1 int` �7��4,� r ya i de by the rules and
regulations for permi ins .as` dut11 ned 1 n t�eM f M,Sci�uth Windsor's Street
Cut Permit Manual
* * f ERMIT TO`�= F��T .pN S TE AT ALL TIMES.
'II
Issued by
71.t e
Date Completed -'
` / Inspected By
: a7yt-
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ed)L \0 Phone No.
Address of Firm (fir,
Location of proposed work 2 o !EL
Describe fully nature of permit requested A- .p
Starting date al Approx.time for completion I d
Call Before You Dig No. a l Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
Q 5 No.cuts
Amt.of Deposit$ 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 date
the Police Dept.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: o�
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
-- __-Standard Forms\Permits\Street Excavation Permit.doc