HomeMy WebLinkAboutCAble Street Cut Permits Paper Chase Permit No. 2558 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descri p: INSTALL 8' GROUND ROD C�q 1 = APER CHASE
ApplicantM Location
4
Name COX COMMUNICATIONS =rb P sf y g ,T � N 1 &43
Addr.. 801 PARKER ST. ` s 5° v
06040 CT 06040 7`yp p Nlor CABLE
Phone (860)512-5000
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Applicant agrees' �' 1Ndsor the amount of bond
required and to reinbur, tie lot �k �uthttf or for any expenses
incurred by the Tovn1"pr rep , vcr ��� in connection with this
permit and that app oer � � W1, abide by the rules and
regulations for permitil � 1 0 1 ��' f `5outh Windsor's Street
Cut Permit Manual . r'
* * PERMIT T� `.
t �tBwTE T ALL TIMES.
Issued by L / g, e
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKSDEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. Y&l
Address of Firm -
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig.No.z-99g 6 i7/ Traffic Services Control No.
Show sketch of proposed work or furnish _ To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
n
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Athit. Clue 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 �r Date:—
Title:—
-- - fir— --�--
�- _ —�� D.L.#'
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc