HomeMy WebLinkAboutCAble Street Cut Permits Between 144 and Permit No. 2577
Date 02/17/1999 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 02/17/2000
Descrip: INSTALL 8 ' GROUND ROD F0R °CA V---,-.WOOD POND ROAD
Applicant
x Location- � ion
Name COX COMMUNICATIONa a �
Addr. 801 PARKER ST. laEl '. 44&154
06040 �
CT 06040
Phone (860)512-5000 _ - Yp'� of Work CABLE
Applicant agrees �+ f h
required and to re i +re
� o '' of a dsor the amount of bond
s � �
uth s6jr for any expenses
incurred by the Tow�
permit and that app � ep i n connection with this
regulations- for °�A �i. abide by the rules 1 es and
permit a � South Windsor's Street
Cut Permit
Manual .
* * PERMIT TO ATE AT ALL TIMES.
Issued by -
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 $25.00 '
Name of Firm Phone No.�(�'
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No.Z?FY 6 7co oo Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm.Patch
No. Cuts
Final.Blling$
Amt. Due Payee
Amt. Due Town$
Applicant is responsible for contacting by dat
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: , C, -!..3 ea o D.L.#:
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc