HomeMy WebLinkAboutCAble Street Cut Permits 101 Windy Hill 1
Permit No. y 2754 Town of South Wind
Date 07/,06/1999 sor, CT
Street Excavation Permit
Expiration Date 07/05/2000
Descrip: CABLE TV
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Applicant Location
I
Name COX COMMUNICATIONS14CwWIND ILL DRIVE
Addr. 801 PARKER ST.
06040 CT 0604.0 CABLE
Phone (860)512-5000
Applicant agrees t�i � G � � �9 �� = hot f SoLt '� iadsor the amount of bond
required and to reimbt r,�s8r� =e ov n�, a �' " h W� ��
o any expenses
incurred by the Town o ► e a
� connection with this
permit and that appl ian #�a► ' d�� AI y
regulations 1 at i ons for � ��`ide b the rules and
9 permit$ tt ,, rae , S.otath Windsor's Street
Cut Permit Manual w y ti�-� v »u � '
* 4PRMIT
TO LL TIMES.
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Issued by1
Date Completed Inspected
p ed By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm L—O Cctuc Phone No. 6'6o S0- F6
Address of Firm o I rTt ST
Location of proposed work D/ H, / [ r
Describe fully nature of permit requested eTV
Starting date Approx.time for completion O �
Call Before You big No. 9 2 9 412 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Wefe r Prop. size of cut
No. cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
I
' 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:
Title: 0�2 D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc