HomeMy WebLinkAboutCAble Street Cut Permits 14 Stanley Driv Permit No. 2907
Date Q1/18/2000 Town or South Windsor, CT
Street Excavation Permit
Expiration Date 01/17/2001
Descrip:
App l i cant
Location
Name COX COMMUNICATIONS
Addr, 801 PARER ST. 00
t4TAI�LJY DRIVE
06040 CT 06040 .,;
Phone ( 860)512-5280 Otk
CABLE
F
Applicant agrees „the Own �.� ray f d`sor the amount of bond
required and to reimkxue,:fi�i+ �. th1s`t r .for any expenses
incurred by the Town for ten �epai ' u, o:irk -,in connection with this
permit and that applicant ;fa Aar-Wi y wi,l . aide by the rules and
regulations for permis ;. s i nod °~n th x South Windsor's Street
Cut Permit Manual .
* PERMIT O $E KEPfi` QN .. pg STTE' AT ALL TIMES.
Issued by _
Date Come ed '- Inspected
p By —
APPLICATION FOR
STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm
Address of Firm ` Ph ne No,
Location of proposed work
1
Describe fully nature of perm' requested
tx
Starting re a Approx.time for completion
Call Before You Dig 0 3 3 Traffic Services Control No.
Show sketch of proposed work or famish To II u b To n of Sogth Wi dsor
two-copies.of separate drawing T w n
Indicate North
Pa— n
Prop.size of cut
No.cuts
Amt.of Deposit$ b
� y
1 O Cash{)Check# _
Cut size after Penn. Patch
No. Cuts
Final Billing$
Amt.Due Payee$
Amt.Due Town
Applicant is responsible for contacting b
the Police Dent-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 bR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES TOWN OF SOUTH WINDSOR'S.STREET CUT PERMIT MANUAL. AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
Signed: 001f
Date: 1
Title: ceyj ,�J
D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Ucavation.Permit.doc