HomeMy WebLinkAboutTelephone Street Cut Permits 180 Scott D Permit vo. 2 55
Date 10/25/199b i.own of South Windsor, CT
Street Excavation Permit
Expiration Date 10, CABLE PEP/25/ 199"7
Descrip' TELEPHONE CABLE �_ACEMENT IN VICINITY 4F 160 SCOTT DR
Applicant
Location
Name CABLE CONSTRUCTIUh6 CU. , V i CIN rY t7- ;180 SCOTT DR
Aadr . 405-D NEW S-rATE ROAD,
MANCHESTER C"i 06040 rYpe 4 Work TELEPHONEPhone ( 860)649-821 ? t
Applicant agrees to four 7 sh ti'te 1 own of South Ali nrts r the amount of hand
required and to reirnbursP hr� Town of South W1' 6d6o1r, far any expenses
r
incurred by the Town for' m, iptenance g repair work ��n1connection with this
permit and that app-iicant i S fam' li„ar with and w� 11 abide by the rules and
regulations for perm; ts as �aut'llned 1n the Town of SoUtr. Windsor 's Street
Cut Permit Manual .
G
kRMI -i' T�k� "EPT ON JC1i3 SITE AT ALL TIMES. � 9c
Issued by
- , f
Date Compi Stec! 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 C'i4—�/c � ST C�r "�'�• Phone No. Sri
Address of Firm tea• /Ve�ci J`T�'¢C
Location of proposed work
Describe fully nature of permit requested �TI9�� s•`✓/ACC.r���ti� � � Ce-+--G�u�>�
Ta_ /1r phZo�-c Se-- :c 7v s ic.Sc s --
Starting date Approx.time for completion
Call before you dig no.965o W-3 O-A f9(y vim. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North ' �D Prop.size of cut 3
—— No.cuts
_."t Amt.of Deposit by
()Cash()Check#i
30�
Cut size after Perm. Patch
L No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town$
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. by date
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 SOUT INDSOR'S STREET CUT PERMIT MANUAL.
Signed K�'� Date:
Title: ' � '�% D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
v� 10