HomeMy WebLinkAboutCAble Street Cut Permits 8 Tuttle Circle PF.rmit. No. 2845
Gate 08/27/1999 Town of Soutn Windsor, CT
Street Excavation Permit
Expiration Date +�8/25/200p
Descrip: CABLE SERVICE
Applicant
Location
Name COX COMMUNICATIONS
Aadr. 801 PARKER ST. 0008 T'UTTLE CIRCLE
0860) CT 5280 Type of Work CABLE
Phone (860)t�12-5280
Applicant agrees to furnish the Town of South Windsor the amount of bond
required and to reimburse the Town of South Windsor for an,, expenses
incurred by the Town for maintenance; or repair work in connection with this
permit and that applicant is familiar 'with and w101 abide by tthe rules and
regulations for permits as outlined in the Town of South Windsor ' s Street
Cut Permit Manual .
* * PERMIT Ta BE KEPT ON JOB, ,SITE AT ALL TIMES. �
Issued by y
Title
Date Completed _ -
--..-- _ Inspected By
+
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm� Phone No.
Address of Firm
Location of proposed work U p
Describe fully nature of permit requested_ rQS�
Starting date Approx time for completion_
Call Before You Dig No._j 011 ST !2 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Wind
two copies of separate drawing sor
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
O Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
e� Amt. Due Payee$
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.
Signed. ¢
Date:_
Title:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc