HomeMy WebLinkAboutCAble Street Cut Permits 71 Sally Drive Permit No. 2752 Town of South Windsor, CT
Date 07/06/1999 Street Excavation Permit
Expiration Date 07/05/2000
Descrip: CABLE TV r.
Applicant Location
P
Name COX COMMUNICATIONS � ,, �;� 0 `1 "' " �IVE
Add r. 801 PARKER ST
06040 CT 06040 ABLE
Phone (860)512-5000
Applicant agrees tQ 4)th f S i+adsor the amount of bond
required and to reimbi see ` ' 'owr► ` � h W rr any expenses
incurred by the Town k�., � connection with this
permit and that app1idan� a �W� � � ide by the rules and
regulations for permits .. o*uth Windsor's Street
Cut Permit Manual
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* P RMIT TO ` PTw Na i 1•i , ATt,-ALL TIMES.
Issued by Ta t1`e�
Date Comp le ed - Inspected By
k C)
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
` FEE $25.00
Name of Firm �4 C+�l Phone No.
Address of Firm OI r Pf- -f
Location of proposed work 7/ ` //� r^
Describe fully nature of permit requested C'46/P TV
Starting date a� Approx time for completion I-LO �f S
Call Before You big Ko. 1922 270 aZ 5' Traffic Services Control No
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
-7 1 i Amt. of Deposit$ by
r
()Cash ()Check#
Cut size after Perm. Patch
P 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: -7 1
Title: - D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc