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HomeMy WebLinkAboutCAble Street Cut Permits 10 Pepperbush W Permit No. 2624 Town of South Windsor, CT Date 03/05/1999 Street Excavation Permit Expiration Date 03/04/2000 Descrip: HOUSE CONNECTION 6 6n pp A 1 i cant , Location on., i Name COX COMMUNICATIONS SF� Q10: PIUSH WAY Addr. 801 PARKER ST. 06040 CT 06040 type � Wok* CABLE Phone (860)512-5000 �e dl r Applicant agrees f�tsh tkT pf S1trrior the amount of bond required and to re i mbse ; a�Town t � h � ', ,� r. f r any expenses incurred by the Town ;fc 'M''di �� � ; air connection with this iY A y tlS' M 0 0 eM permit and that app 1 i scat art i de by the rules and regulations for � era ti,, f`° uth Windsor's Street Cut Permit Manual. ° * ERMIT TO' ,� � � � � P ©1"1 1 "A, ALL TIMES. * * Issued b � r , e , Date Comp l bto <5 y o Inspected By , A a�ay APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm ab*1 Phone No. Address of Firm Location of proposed work 18 et eY' S x L.1-114qL Describe fully nature of permit requested Starting date Approx.time for completion Call Before You Dig b. F6 6 4 Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North Prop. size of cut No. cuts 1 Amt. of Deposit$ by ( )Cash ( )Check# Cut size after Perm. Patch No. Cuts Qe� 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 NDSOR'S STREET CUT PERMIT MANUAL. Signe Date: —5/l/l /c Ci Title: D.L.#: PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc