HomeMy WebLinkAboutCAble Street Cut Permits 7 Vincent Circl Permit No. 2737
Date 06/24/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 06/23/2000
Descrip: CABLE TV
. Applicant Location
Name COX COMMUNICATIONS °y� g007 ;,VN CIRCLE
Addr. 801 PARKER ST. �'"
06040 CT 06040SABLE
Phone (860)512-5000
Applicant agrees to uFih�,"the T� e i�` f l
required and to re i mbuse<' ;or the amount of bond
Tom #� �► th rfbr any expenses
incurred by the Town fo,r
13 tten� epa i )- connection with this
permit and that ,app 1 i carrt� � Ufa i de by the rules and
regulations for permits:" as ,'ruliri' + 'a� pf, d,uth Windsor's Street
Cut Permit Manual
* * PERMIT TO $6 Fps' ( A"T.°ALL TIMES.
Issued by
Date Completed(' _ Inspected By
0731
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm Phone No. J�a
Address of Firm S
Location of proposed work C®N
Describe fully nature of permit requested e N
Starting date Approx time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed wor or furnish To be filled out by Town of South Winsor
two copies of separate drawing d
Pavement Cut
Indicate North Prop.size of cut
K, No.cuts
SW Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt.Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by
the Police Dept.and C.B.Y.D. 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: 6� 6 Date:- l Q � le�
Title:
PERMIT SHALL BE KEPT ON 3 E AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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