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HomeMy WebLinkAboutCAble Street Cut Permits 40 Quail Run (2) Permit No. 3037 Date, 04/25/200i Town of South Windsor, CT Street Excavation Permit Expiration Date 04/25/2002 Descrip: BORING UNDER ROAD N Applicant Location Name COX COMMUNICATIONS w�.• , Add r. 801 PARKER ST. �\l(UN'`• 06040 CT 06040 Type of Vo k CABLE Phone (860)432-5211 Applicant agrees to irurn 'sh ,the Tech ®fautf�. Windsor the amount of bond required and to re i mbu��4 Totyouth Wtidsor 'for any expenses incurred by the Town ,i or �i: teranc .roe "re pa i r work in connection with this permit and that appl ic°�xrtt �` fer and . "ti abide by the rules and regulations for permits , ae ;Pitt i i 66d,, vtvr - cif South Windsor 's Street Cut Permit Manual . * PERMIT T` KEPI' t?Nt .IC)8 SITE ; AT ALL TIMES. »� Issued by --�-- _ _ Tit1e Date Comp l eiie �O�Z Inspected By — .. � APPLICATION FOR ST TOWN OF SOUETT EXCAVATION PERMIT - PUBLIC WORKS pEp INDSpRRTMENT _.----- TOWN HALL 1S40 SULLIVAN gVENU SOUTH WINDSOR, CT E Name of Firmel"y© FEE $25•00 Address of Firm (� Location of proposed work µ Phone No. V � Z�Q Describe fully nature of per requested -�, — Starting date � Y � ®Call Beforeou DigNo� �: ® Approx. time for completion IS .101111 Show sketch of proposed work or furnish Traffic Services Control No. two copies of separate drawing To be filled out b Town of South Windsor Indicate North Pa ve __.. men C Prop• size of cut • „�� No. cuts Amt. of Deposit$ b ()Cash ()Check# y Cut size after Perm. Patch No. Cuts Final Billing$ Amt. Due Payee$ Applicant is responsible for contacting Amt. Due Town$ the Police De t. and C.S.Y.D. by I AGREE TO FURNISH 70 THE TOWN OF SOUTH WINDSOR THE A date SOUTH WINDSOR FOR ANYETOWEXPENSES INCURRED BY THE TOWN FO PERMIT AND THAT I AM FAMILIAR WITH ANDINCURRED WILL ABIDE BY TH MOUNT TE BOND RE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. R MAINTENANCE OR REPAIR WORK IN CONNECTIONE TOWN OF E RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN T WITH THIS HE Signed: Title: Date: D.L.#: PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc DIG SAFE NUMBER 2001 / n i3 a- A � Conn Ph 800-9224455 DIG SAFE CLEARS ON (.� a �- Contractor#1167 AT 7:00 AM Date L /01 EMAIL CITY STREET ADDRESS �ID Q- / 01IA CROSS STREET ���! ri�:�/ CHANGE IF DIFFERENT WORK; InStelling CATV DEPTH: 24" AREA PREMARKED ?: Utilites Notified: � YES R v ,v C -5j� l � � gU I fO J I