Loading...
HomeMy WebLinkAboutCAble Street Cut Permits 140 Rockledge D Permit No. :301�� Town of South Windsor . CT Date 08/09/200 t Street Excavatior Permit Expiration; Late 08/08/2001 Descrip; FROM 121 TO 140 ROCt LEDGE DR JACKING UNDER ROAD 4PP i i ;ant. -ocat i on Name COX. COMMUNICATIONS 0140 ROCKLEDGE DRIVE Addr . 801 PARKER ST . 06040 CT 06040 Type of Work CABLE Phone ( 860 /1432-5211 Applicant agrees to furnish the Town of South W%ndsor 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 it connection with this Permit and that applicant is 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 . PERMIT T,¢ BE KEPT ON JOB SITc- AT :�ALL TIMES. � .7f�.,� Issued by Title -- - Date Completq'd __.___ �___.__._.— Inspected By APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORDS DEPARTMENTd 1 d TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $2�5.0p-- ICJ 0AJE7' Name of Firm Phone No. Address of Firm U i Location of proposed work !A,�� �• •,�. �p�� Describe fully nature of permit requested Starting date T—J O —©-n Approx.time for completion Call Before You Dig No. ffic Services Control No. Show sketch of proposed work or furnish two copies of separate drawing To be filled out by Town of South Windsor �IBn Cut Indicate North Prop. size of tut iut No.cuts Amt.of Depo sit b Y {)Cash{)Check# S Cut size after Perm. Patch top& No. Cuts Final Billing Amt.Dua Payee.$ 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: n..e_ Date: Title:—.—GOA 14 O:. D.L.#: PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES -- --Standard-Farms\Permits\Street,Excavation Permit.doc Ph: 888-344-7233 -,,;ID#17930 Fax 781-721-0047 2000 33 ao&9?' DIG SAFE NUMBER Conn: Ph: 800-922-4455 DIG SAFE CLEARS ON /O AT 7:00 AM Contractor#1167 Date /00 MAIL MUNICIPALITY STREET ADDRESS & DESCRIPTION (Apartments&Condo's must list name of complex•Or list the f� number of feet from the cross st as well as N,E,S or W) — / y(� IP OCK` -� r'a► ZeZ a .rv�� � rC e f �� �ree6e// ��r �� o h�us e - !ya CROSS STREET P, i j e AREA MARKED ? YES WORK: Installing CAN Utilities Notified:: 'C�.tP �/Q,1L1C.Q.,Q_ C C.,Tlja± A yJL DEPTH: Zr �(,l 1Lt�i/1C�c5 �SAl T Z 0 DeeF� 3d X � � o c /r"J,7 -C- D� D� d � 21