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APPLICATION AND PERMIT FOR SPIiElt SERVICE
CITY STATE
PERMIT NO. 3-�ia 4- 317/3
Application is hereby made for authority to connect the premises at
No. Street, Ave., Lot//_r_ Bloc
Addition with the city's sewer main on
Street, Ave., by
a inch V.C.P., or C.I.Soil Pipe. Connection 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 resilient
properties ASTM C425-64. Installation shall conform to ASTM specifi-
cations C12-64. No pipe smaller than six (6) inches shall be used.
All material and workmanship will be in strict compliance with City
Ordinances relative to such work and shall be approved by the Sewer
Superintendent before and after backfilling. Noncompliance may
result in (A) Digging up and redoing complete installation, (B)
Denial of future application for permit, (C) Denial of water connection
until (T=
factory.
.i a""
1f CLERK 61 OWNER OR AUTHORIZED PLUMBER
To be filled in by installer before backfilling will be authorized.
PERMIT NO. DATE NO. STREET
LOT BLK.
OWNER
SIZE OF PIPE KIND
ADD.
LOCATION OF TAP FEET _
FROM LINE'OF ST.
DEPTH OF MAIN SEWER FT. E4TEf `LOT AT FT.
FROM LIA,.OF '~ ST.
�L� ��
DEPTH OF PROPERTY LINE FT.
PLUMBER
REMARKS
1( " 1 77 CITY INSPECTOR
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