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APPLICATION AND PERMIT FOR SEWER SERVICE
CITY STATE
PERMIT NO j'%7 <%vv
Application is hereby made for authority to connect the premises at
No Street Ave., Lot r, o ¢lock/. —
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 ASTid 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 work is satisfactory.
CITY -CLERK OW R OR AUTHORIZED PLU•iBER
To be filled in by installer before backfilling will be authorized.
PERMIT NO. DATE NO. STREET
LOT BLK._ _ _ADD.
OWNER l )- X✓. �j�.�� r��r
SIZE OF PIPE KIND
LOCATION OF TAP FEET
FROM LINE OF ST.
DEPTH OF MAIN SEWER FT
FROM LINE OF_
DEPTH OF PROPERTY LINE
PLUMBER
REMARKS
ENTERS LOT AT
CITY INSPECTOR