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HAMILTON WESTERN UTILITIES. INC.
1350 Greyhound Court
Carmel, IN 46032
(317)846-6561
DATE. A,igust 5, , 19s/
RECEIVED FROM: C.U. e"DR{JlIN
ADDRESS: 1980 E. 116th Suite 125
2Ch77 c7 1 01 1 1299
LOT4 9'i , LOCATION 1151aterG KJio?1, , SECTION fi F
Lot Address: 1.3709 'dellis Q-)urt:
WATER CONNECTION FEE
SEWER CONNECTION FEE
INSPECTION FEE
*DEPOSIT - WATER
*DEPOSIT - SEWER
*DEPOSIT - WATER SHUT OFF
*MISC
25. 00
09.,,E n
L3U..
PD: /
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It is hereby agreed that a $1,000 penalty will be charged any builder
introducing any water into this sewage system other than sewage effluent.
Sewer lines must be of acceptable quality, PVC with self scaling joints
or CAST IRON pipe with 0 -ring or leaded joints. AL1 -joints must be leak proof.
There is a 6" wye to serve the lot on the left and the right. If a smaller line
from the house to the wye is used, it is mandatory that a reducer be used at the
connecting line.
Basement floor drains are not permitted. Water closets installed in
the basement must have "back water" valves.
Sump pumps, perimeter drains or area drains must not be connected to
the sanitary :fewer.
ALL SEWER LINES ARE TO BE APPROVED AND INSPECTED by Hamilton Western
Utilities, Inc. PRIOR TO COVERING. Failure to do so will result in uncovering
water line at the expense of the builder.
ALL WATER LINES ARE TO BE APPROVED AND INSPECTED by Hamilton Western
Utilities, Inc. PRIOR TO COVERING. Failure to do so will result in uncovering
water lines at the expense of the builder. r
WATER SHUT-OFF VALVE IS TO BE APPROVED AND INSPECTED BEFORE AND
AFTER FINAL GRADING by Hamilton Western Utilities, Inc. Failure to do so
will result in locating and uncovering shut off at the expense of the builder.
*After the completion of all inspections and approvals the $300.00
deposit will be returned. We will need one (1) day notice for inspection.
By signing this form builder acknowledges that he has
received a copy of this and fully understands the contents.
BUILDERC.P.'r tors.:. --^_n. HAMILTON WESTERN UTILITIES, INC.
BY: ) ,l .�-+ tJ(:ix < <, .c,ci,i t BY:
Kathy 3 . iY ardt ' Kua '40..",lanahr:n
Water and Sewer Lines to be installed Inspection - Water By:
Sewer By:
BY: Dickens 1 aca.var_int� Shut-off By:
Meter # Shut-off Location
Remote # from curb
PLUMBER= L/R of drive
Received By: Remote Location Reading
Installation Date:
Route / Sequence
Sewer Connection:
Direction from Manhole After Construction
Feet from Manhole Feet from Driveway:
Feet from curb ft. left/right