HomeMy WebLinkAboutCAble Street Cut Permits 56 Partridge La Permit No. 2625 Town of South Windsor, CT
Date 03/05/1999 Street Excavation Permit
Expiration Date 03/04/2000
Descrip: HOUSE CONNECTION
Applicant Location
Name COX COMMUNICATIONS x3 'S LARGE LANE
Addr. 801 PARKER ST.
06040 CT 06040 Type " Mork (CABLE
Phone (860)512-5000
Applicant agrees to,,, fur, r1�' t � Tcir � tfs 4Vidor the amount of bond
required and to reimburse `# 'Town ;o ��h War`fOr any expenses
incurred by the Town l�t fie. aiil rk-Ah connection with this
permit and that app l i t a� � aa^�� �Qy 1 T" b ide by the rules and
regulations for permitisds'° are tte . cw� 1o 'S,iuth Windsor' s Street
Cut Permit Manual �' �. 4�
* PER TO 'BEKi`PT ,1t 8 SI F AT ALL TIMES.
Issued by ._Ti"ale e it
Date Comp1et�d S
Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. 0 JZ4 Q Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
L' c�s' Final Billing $
1]e,J
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
TOWNaO�F�S�UTH WISOR'S STREET CUT PERMIT MANUAL.
Al
Signe Date:Ttf�S
Title: D.L.#:
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc