HomeMy WebLinkAboutInstall 8 ground rod for CATV Street Cut (2) Permit No. 2541 Town of South Windsor, CT
Date 02/16/1999 Street Excavation Permit
Expiration Date 02/16/2000
Descrip: INSTALL 8' GROUND ROD
,zf-OR,"GA -���ARROWWOOD CIRCLE
Applicant Location
Name COX COMMUNICATIONS ' T�EIh 284, BETWEEN 12&16
Addr. 801 PARKER ST. �" �
06040 CT 06040 ° YP o Wr CABLE
Phone (860)512-5000
Applicant a f pp agrees 9Etrthw,.of � ° ihdsor the amount of bond
required and to reijnbur t o To 1 puth �i i"r�for any expenses
incurred by the Tow fo * ,ep T K,,. ,, in connection with this
permit and that appl�yga6iu I't' abide by the rules and
regulations for perm=i os =,atdln , t f South Windsor's Street
'77 -
Cut Permit Manual .
*�* PERMIT T`0 `B El b3� 9'CB, i-TE �T ALL TIMES.
Issued by / tlE.e
m \/
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firmer
Address of Firm Phone No. .
Location of proposed wok oe
Describe fully nature of permit requested l 8rcve+o
Starting date Approx.time for completion
Call Before You Dig No. J&g.4 o i0 ) Traffic Services Control No. -
FIndicate
f proposed work or furnish To be fill ut b Tow of uth�ind r
eparate drawing ed o v n So so
Pavement Cut
Prop,size of cut
No.cuts
Amt.of Deposit$ by`
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town
Applicant is responsible for contacting b
the Police Dent. and C.B.Y.D. y date
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 TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. AS OUTLINED IN-THE
Signed
Date:_ ,//�
Title:
D.L.#• _
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doe