HomeMy WebLinkAboutCAble Street Cut Permits 120 Rimfield Dr Permi.,t No. 2676 Town of South Windsor, CT
( ate 05/05/1999 Street Excavation Permit
Expiration Date 05/04/2000
Descrip: BORE SW FOR CABLE SERVICE
Applicant
Location
Name COX COMMUNICATIONS DRIVE
DRIVE
Addr. 801 PARKER ST.
06040 CT 06040 " Or CABLE
Phone (860)512-5000
Applicant agrees tO furriih . I W,ndtor the amount of bond
TiAlq
required and to reimbufse .fie ` iJwn �t� t' 1eoru. 0r any expenses
incurred by the Town four CC� trtien '�1"; repair y connection with this
permit and that app7 ic'ant i fanii iwl-dr and s .'.wide by the rules and
� f
regulations for permit ToW 18uthWindsor ' s Street
Cut Permit Manual .
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PERMIT . P � �.J°4TTA . �AL TIMES.
Issued by �- �
T J to he lNG��u
Date Completed
Inspected By
f.
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �� C
Address of Firm Phone No. U�
Location of proposed work e
`E
Describe fully nature of permit requested (l
Co45 s n/i c
Starting date ;' q
Call Before You Dig No. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out b Town of South Windsor
Indicate North Pave �t
OZI� Prop. size of cut
No. cuts
Amt. of Deposit$ b
Y
()Cash ()Check#
.1 Cut size after Perm. Patch
r ( No. Cuts
Final Billing$
Amt. Due Payee$
Applicant is responsible for contacting Amt. Due Town$
the Police De t. and C.B.Y.D. by
date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AN
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR AMOUNT
OF B MAINTENANCE OR REPAIR W
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
D TO REIMBURSE THE TOWN OF
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. ORE IN CONNECTION WITH THIS
R PERMITS AS OUTLINED IN THE
Signed: r-
Title:
Date:10 J
D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc