HomeMy WebLinkAboutCAble Street Cut Permits 166 Norton Lane Ferm'Pt No. 2686 Town of South Windsor, CT
Date 05/12/1999 Street Excavation Permit
Expiration Date 05/11/2000
Descrip: DROP REPLACEMENT
Applicant . .
Location
Name COX COMMUNICATIONS °# RT �I LANE
Addr. 801 PARKER ST. �� ,
06040 CT 06040 4
Phone (860 )512-5000 � `� ' 3�e ° � Wrc;.CABLE
r arm
Applicant agrees to f r,_j i h r
aGi.'. l or the amount of bond
required and to reimbUr. eh ow opWth fbr any expenses
incurred by the Town or m P �, a
�; P p � kM connection with this
permit and that appl iCanii 1s iraml ] uth anc
regulations for � � by the rules and
perms '"� �s To B o th Windsor's Street
Cut Permit Manual .
x
* * PERMIT TO, �' TIMES.
Issued by
Date Comp 1 e ed spected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm /e Phone No. ,�—Ia 0
Address of Firm )-Pler St-
Location of proposed work R-TV w A/
Describe fully nature of permit requested ccge',. es.
Starting date r 1 TZ a q Approx.time for completion
Call Before You Dig No. 1qq q a0 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
5 Uj Amt. of Deposit$ by
G` Qa�U1e� OCash OCheck#
---�' 1Q r. Cut size after Perm. Patch
No. Cuts
1
Final Billing $
fV Amt. Due Payee$
Amt. Due Town$
L�
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 WINDSOWS STREET CUT PERMIT MANUAL.
Signed: Date:
Title: �� ;� c z,� D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc