HomeMy WebLinkAboutCAble Street Cut Permits 41 Sycamore Roa Rermlt No. 2969
Date 05/ 15/2000
Town of South Windsor, C-T
Expiration Date 05,/15/2001 Street. Excavation Permit
Descrip : REPAIR CATV !'--'ABLE
Applicant
Name COX COMMUNICATIONS Location
Addr. 801 PARKER ST. Ot14i
SYCAMORE ROAD
06040 CT 06040
Phone (401 )82 1-1 9 1 9 Type "of WoI rl.. CABLE
Applicant agrees to furr- ish the Town 'of South,
required and to reimburse the'�Town f ' ,
Windsor the amount of bond
incurred by the Town Tor r'r�a'intensrrce or�repa�Jrnwor, l� 'for anyexpenseS
'ur^:ermi t and that app 7 -� cant is familiar with and w ; l I n conbnect i on with this
t Potions for o�ermits as, outianed in the Yowr of
ut Permit Man�.�ai . Y the rules and
mouth Windsor ' s Street
* * PERMI?' TO B� KEPT
�7, ON JOB SITE AT ALL TIMi_b. * k Issued by <y '
Date Camp letec
Inspected By
76, 7
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm_�'0� C'c�H k.t ), a( C.- 7- 1 Phone No. •5 ti a-���
Address of Firm.
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No.;2 cXO;42992 ,4 L_Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
?:I' b:
I Amt.of Deposit$ by
O Cash O Check#
LA Cut size after Perm. Pat
ch
No. Cuts
t3cE Final Billing$
P�1J
SjCA-KCXe1?-- (_,kj, 'PED 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:
Title: �',iy ,� ,Q v D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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