HomeMy WebLinkAboutCAble Street Cut Permits Sea Pave Drive/ f 0Wt\t OF SOUTH 'NI ttl)`�UR )_NIS P E C,J! 1:JN RC PC)FR J-
Permi t No. 2920 Contractor CUX COMMU ,I:T(CATIONS
L.ocat i on BETw.. TEMPLE OR . /SEA PA,VF V)R Address 80 t PARt.E_t; ST .
Type Work. CABLE: MANCHE SI ER ,C 1
06CM-0 CT 06040
Phone No'. ( 401 )62 ? 1919
Date Insp Needed _. _.`_. _ _ mate Insp._
Time Insp Needed - ---- - -- -� _' �.' - T-i crie Insp' ----
Inspected By
Work in Progress __--
I nput Date
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Perm , t No. 2920 Town of sou r.n 'W i r'd car , ("'I"
Date 013/07 /2000 it:reet Excavat.ion Permit.
Expiration Date 03/07% J00I
Desc:r ip : INSi'Ai_t_ING 2 - C011UUIT FROM P LF 40G U N D E,R S` TWEET TC, ;219
Arai I t r.,atit. L ocat i.C:f)
Name COX ( 0MMUNJCAl')'0NS BETW.' it-,MPt..E ter% . !St: A aPAvE
Addr . Sty I I-ARKE}< Si- ,
0604i C:T U6040 T vPe 'ot rotor i- C ,est_L
Phone t 401 i K 1 - I ;a 1 "
Aop l -i c.ant agrees to f urlivi h ` ,he Town of South Wi n&sc r the imount cif borlu
required ana to re 7 mbi.vr`se the T)wn of SOUth Windsor tot-, anv expenses
incurred by tt-te TC;wn .(or tiia ritcnance or reua`i r- 4ork in connect.ion with this
permit and th it with and will i-Auiiae by the i-Lt1e - and
r'e'gU.I at 1 orts ifor oeF rm i Is a& ow. I i ned in, the Town oi- South W 1 ndsor' ' S Street
Cut Permit. Manua l . or
*t G%Et hlI: I r U at: KEPT ON JC,Es' S.T-I L AT AL.1.
Issued by Titie
Date Completed =rlsr)ectect BY
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
_ TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm B n r'1 D IC) Phone No._ S D ^• � �a
Address of Firm 1'7 0 7-010
Location of proposed work ® A2,
Describe fully nature of permit requested )4v-,q- y
.Startingdate "IV—don Approx.time for completion
Call Before You Dig No.-2innGtL='74P$ Traffic Services Control No.
Show sketch of proposed work or furnish two copies of separate drawing To be fried out by Town of South Windsor
Pavement ut
Indicate North Prop.size of cut
0�
No.cuts
7 Amt.of Deposit$ by
(djU2L74t i {)Cash OCheck
f
� Cut size after Perm. Patch
QCiJ f D No. Cuts
Final Billing$
AID 3f>
Amt. Due Town$
Applicant is responsible for contacting by date
the Police De t.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.
i
Signed: -2s-onmaDate:
Title•
D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Fgrms\Rermits\Street Excavation Permit.doc