HomeMy WebLinkAboutDriveway Street Cut Permits 114 Rockledg "own of south Windsor, CT
Permit No`, 2801 Street Excavation Permit
Date 08/05/1999
Expiration Date 08/04/2000
Descrip: CABLE SERVICE
�> ",LoCati on
Applicant
Name COX COMMUNICATIONS
0114 ROCi<LEDGE DRIVE
Addr. 801 PARKER ST .06040 CT 06040 Type of Work ,DRIVEWAY
Phone (860 )512-5280
Applicant agrees to furnish the Town of South Windsorathe amountny of bond
p.
required and to reimburse the Town of South Windsor with
incurred by the Town for mainfam 1iartenance owithpair and work in ill abidenbycthenrules and
permit and that applica,nt' is
regulations for permits as outlined in the Town of South Windsor ' s Street
Cut Permit Manual .
PERMIT TO BE KEPT ,ON JOB' 'SITE AT ALL TIMES.
Title _-. __.__--___
Issued by
Date Completed __ �_ Inspected By --.--.--.
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
-SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �U l� � Phone No.
Address of Firm
Location of proposed work q-p
Describe fully nature of permit requested C
Starting date W11,019T Approx.time for completion old b 04
Call Before You Dig No. Traffic Services Control No. 91
Q361dQ
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
P`1 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 WINDSOWS STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
- Standard Eorms\PermitslStreet Excavation Permit.doc s