HomeMy WebLinkAboutCAble Street Cut Permits 120 Skyline Dri Permit No. 3098 Town of South Windsor, CT
Date 04/2512001 S 3 Street Excavation Permit
Expiration Date 04/25/2002
Descrip: UNDER SIDEWALK.
Applicant ,! , Location
Name COX COMMUNICATIONS
Addr. 801 PARKER ST,
06040 CT 06040 = '
Phone (860)432-5211
CA 8 L E
Applicant agrees isoR°fUrrr1teh the D th,'1�l dsor the amount of bond
required and to reim f; mouth W,-T;n0)13�oe for any expenses
incurred by the Town fflr an a� r'epai Wo .in connection with this
permit and that app 1 i cat f� r W anti 1 1 Abide by the rules and
regulations for permis as tle '- T ofquth Windsor' s Street
Cut Permit Manual . �
PER IT T EST = , BITS AT ;ALL TIMES.
Issued by T it le' r _
Date Completed o zz , Inspected 8y 1
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm
Address of Firm Phone No.
Location of proposed workLA
ML
U
Describe fully nature of permit requested
Starting date_
Call Before You Dig No. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North
_ -- Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
----
Applicant is responsible for contacting b
the Police Dept. and C.B.Y.D y. 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 SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �`1�rP
nn
Date:_' A-0\
Title: f) a. Q
D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
DIG SAFE NUMBER 2001
7-n , -.�,Ll<-
Conn: Ph: 800-922-44e5 DIG SAFE CLEARS ON a�'
Contractor#1167 AT 7:00 AM
Date 445-101 EMAIL �
CITY l j I/61435)0
STREET ADDRESS /z� S�' I.AJ
CROSS STREET
CHANGE IF DIFFERENT: WORK:' nstalling CATV DEPTH: 24"
AREA PREMARKED ?: YES
Utilites Notified: Cr2 CTLaigCo x
`S A/ T
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