HomeMy WebLinkAboutCAble Street Cut Permits 117 Wentworth D Permit No. 2735 Town of South Windsor, CT
Date 06/24/1999 Street Excavation Permit
Expiration Date 06/23/2000
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Applicant . Location
Name COX COMMUNICATIONS , ` N TH DRIVE
Addr. 801 PARKER ST.
06040 CT 06040 '°
oABLE
Phone (860)512-5000
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Applicant agrees toboft tI T f tor the amount of bond
required and to reimt h r any expenses
incurred by the Town pa i connection with this
permit and that app 1 � 1 i de by the rules and
regulations for permi is ►s uth Windsor' s Street
Cut Permit Manual .
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* P RMIT T6-11,61E111
kP $ � ALL TIMES.
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Issued by �, a ,. Te;
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 $25.00
Name of Firm Cd Jam- C 04Y-P Phone No. J!or d
Address of Firm_ 1rt, Car' C
location of proposed work
t r-
Describe fully nature of permit requested E&12 e -ry
Starting date Approx.time for completion — t4
Call Before You Dig No. Traffic Services Control No.
1991 b.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{.)Cash{)Check#
Cut size after Perm. Patch
No. Cuts
`CU
Final Billing$
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: C.
T
Title: D.L.#:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc