HomeMy WebLinkAbout0380.76 Sewer and Water Permit.pdfJ �
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APPL ATION A�D PEIiMIT FOR EIiER SERVICF
� C I T Y � — "�t'`t-�` °�-
STATE
PERMIT N0. ,�ja� cy �����
Application is hereby made for authority to connect the premises at
No. Street, Ave., Lot_��_ glock ��_ ��
Addition with the city's sewer main on
Street, Rve ;�bY
e inch V.C.P., or C.I.Soil Pipe. Connec-tion will be made
feet North, South, East, West of the manhole located at the intersection
of and
Ask Clerk to see Ordinance S-3 for complete specifications. Clay pipe
shall be ASTM C200-65T. Joints shall be materials having resi)ient
pro�erties ASTM C425-64. Installatian shall conform to ASTM specifi-
cations C12-64. No pipe smaller than six (6) inches shall be used.
Ail material and workmanship will be in strict compliance with City
�rdinances relative to such work and shall be approved Dy the Sewer
Superintendent h�fore and after backfilling. Noncompliance may
result in (A) Uigying up and redoing complete installation, (B)
De of future application fc,r permit, (C) Denial of water connection
un il ork is satisfactory.-
�--� :�� ..- il . (� ,
. ,���. : = /
C CLER OWNER OR AUTHORIZED P UMBER
T e filled in by installer before backfilling wi11 be authurized.
PERMIT N0. DATE N0. STREET
LOT__ BLK.
OWNER
� � �(/ D�. , ADD.
SIZE OF PIPE
LOCATION OF TAP
KIND
FROM LINE OF
DEPTH OF MAIN SEWER FT. ENTERS LOT AT
fROM LINE OF
DEPTH OF PROPERTY LINE
PLUMBER
REMARKS
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CITY INSPECTOR
FEET
ST.
FT.
ST.
fT.