HomeMy WebLinkAboutCAble Street Cut Permits Robins Wood Permit No. 2581 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD .,P db"��' = �- gglN'S WOOD WAY
Applicant Location
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Name COX COMMUNICATION
Addr. 801 PARKER ST.
06040 CT 06040 ypi bf I6 A CABLE
Phone (880)512-5000
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Applicant agrees � Sh o f � ` ►dsor the amount of bond
required and to rei�r,� tie 'outh
�01-11 for any expenses
incurred by the Town Y `
permit and that a � vr, i n connection with this
pp 1 n. q(w `4r abide by the rules and
regulations for perrrffti, �� tf,fSouth Windsor's Street
Cut Permit Manual .
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PERMIT 1 Q1m T .(T ALL TIMES.
17,
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Issued by i� t 1 e G�
Date Completed Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firmed' l �or�allvr��i�v�i`a�r Phone No.
Address of Firm
Location of proposed work y`a
Describe fully nature of permit requested <i �M
Starting date Approx.time for compietion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement C
Indicate North Prop,size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts.
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 WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:-
Date:_
Title: 10 D.L.#•
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PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Pennit.doc