HomeMy WebLinkAboutCAble Street Cut Permits 105 Woodpond Ro Permit No. 2578 Town of South Windsor, CT
Date 02/17/1999 Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8' GROUND ROD , R" AT� , )QD POND ROAD
Applicant ' Location
Name COX COMMUNICATIONS
r h A.�, SOX HILL RD BY 105 &
Addr. 801 PARKER STD
06040 CT 06040 yp V r, CABLE
Phone (860)512-5000 a
Applicant agrees "f �iz. h of`` , pt Wihdsor the amount of bond
required and to reinbrTe To ut isor.jor any expenses
incurred by theTow� zrepin connection with this
permit and that app l irk abide by the rules and
regulations for permbit t5 � " 17
acfP;`South Windsor's Street
Cut Permit Manual .
P
* PERMIT T�3. BE KEPI"°'' �t76 TSeAT ALL TIMES.
Issued by
title � r
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm�Z0.Y 2'�rA 70�a g Phone No. 6�� ga
Address of Firm
Location of proposed work Z67 so
Describe fully nature of permit requested !' . i e; s�6 3
Starting date Approx.time for completion
Call Before You Dig No. 9 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cud
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
{)Cash{)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
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]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit doc