HomeMy WebLinkAboutCAble Street Cut Permits 155-132 and 80- c.. CVO,
Date 2827
08/20/1999
Exp i rat in Town of Sr)uth Windsor,
Date 08/19/2Q0,) Street ExcavatiCT
Permit
Descrip: 155--132 WOODPOND RD. AN
30-1±�5 on
App, ! i Cant
Nacre CC)X COMMUNICATIONS Addr, g0; �-�l�=at i c�r�ti
PARKER ST. 1�g_10,.
06040 CT 016040 ' ANU c 0� t 05
Phone (860 5 12--5280
Type ,of work CAE3LE
Appflc:ant agrees
required and to t° urni tithe
incurred r'eimburSe the 'own Town of South ►�indsor the
permit by the Town for off" South Wuth Wi far amount and that maintenance ' any of bona
regu 1 at i cans far dpp 1 cant s or r"epa 1 r war' expenses
uerm� am7ir with aria wi ? 1 in Connection
Cut Permit Manua ,1 . is as� 0 "tlined abide with this
�?� the Town South by the rues and
th W1ndsor '. Street
* * PERMIT Tp qE KEPT
Issued by C3h1 J0 SITE
z
` � AT ALL 1"IMES, � F.
Date Completed _._ .-- Title _----
--____ Inspecz.ed 8y
ly
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $!5.00
Name of Firm Phone No.
Address of Firm
Location of proposed work — d
Describe fully nature of permit requested- E! i;
Starting date 7 Approx.time for completion
Call Before You Dig No. 3y a Traffic Services Control No.
Show sketch of proposed work or fuLishTo be filled out by Town of South Windsor
two,copies of separate drawin
Pavement ut
Indicate North kProp.size of cut
No.cuts
Amt.of Deposit$ by
q Joyc
� Cash O Check#
�C1Lc!( �l1� `
Cut size after Perm. Patch
d CP No. Cuts
Final Billing$
t3a
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• D 0 / /7` 9
ate:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
- Standard Forms\Permits\Street Excavation Pennit.doc