HomeMy WebLinkAboutCAble Street Cut Permits 112 Pheasant Wa Town of South Winasor , CT
Permit No. 2848 Street Excavation Permit
Vate 08/27/1999
Expiration Date 08/26/2000
Descrip: 112-120 PHEASANT NAY - CABLE REPLACEMENT
Location
Applicant
Name COX COMMUNICATIONS
0112 PHEASANT WAY
Addr. 801 PARKER ST , Type of Work CABLE
06040 CT 06040
Phone � 860 )512-5280
A licant agrees to furnish the Town of South Windsor
anythe
expensesof bond
pP
required and to reimburse the Town of South Windsor
incurred by the Town for maant�m ar vaith and wi" i
aiCo repair
o � at�iaenbeCthen with ruies and
thispermit and that applicant is f
regulations for permits as outianed in the Town of South Windsor' s Street
Cut Permit Manual .
* PERMIT TO- BE KEPT ON JOB, SITF AT ALL TIMES.
,rs ,
Issued by Inspected By
-
Date Completed ___.._. --
_-- ---
N-W
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of FlnTL MIL Or S
Location of proposed work — le2d
Describe fully nature of permit requested
Starting date APP time me for completion letion
Call Before You Dig
N . T
o
g Traffic
Services Control No.
t
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut -
�� UO No.cuts
Amt.of Deposit$ by I
(� O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting c 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 WINDSORIS STREET CUT PERMIT MANUAL.
Signed S l Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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