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HomeMy WebLinkAbout0203.97 Receipt/Permit (2) � ' '� r� �q��� .;�, � ��,'� w;,!��f�S"�,"����' ' . . . . • t ; n.. i , . . , . :tir da � . , � �:�,.:Y �� ry�.. ,. . . i � - . � . 6 ..m.� e ",F . . .. � c r. f �� � • yk i . 5i9, > . � L a aa� :� � . CLAY TOWNSHIP I��GIO�I14L WASTE �IStFtICt � �`""'�t �'� . : � �, EII�ALSANItA1�YSEWER pER�lf r�F"��= ` y 7�'' ` ,w� . `.: " .• 'li t rJ :.0 i l� - Y t t 1�.�, ',�� `i X�� y� - ,. . . F. . . . ' ' i 'yh' �: �.L'�Y . . i � '�'� R-1 �i<(� ,.;J' � 'c'�A'+ f� ��� � . • . : ,INDIVIDUAL �075�/�XISTING BUILbINC3�,{ c� � �,�i�' � �. �� - .. "�. �i�i� { � �" � fn�r ��.,� �'- �t j. �e� R tl r 1 � 3 � ,q . ,. . .., � � ��a�p x�.Ys . $s�;�' r,.. ,� 7 ���,1 am�� �' . /y/ >� :t � �� t �� ��Ir. h u f • Project Ttlle /%�C�iq�L/� ���.at r � :..�u = . _ ,-^ ",, , a . . l .ty'. . ._ . ., . . � g•�`tyt ;£t.^t t te�..pi'�v..i,. ��; �e : ,.. ' . "" /J/� h� � I : Looation:� ..J�I��t/�G ;�/'Ce��,.�._�,,,, , � ' � ..„ .cv-�,,.vw..�.,`.�„-w. . _ _,OwnedBmlder:, ,��li�1' ��D�Es,' LGGrt'�� , 'r .r : �, k, r� �� . t�� _ , ��:. u�.,:-� > ,� ��- . . _ _, - , - , � � � i � .� , . � Lot#�� oT�P� r' SireetAddress �9G�7v� ,�'-v�� �D� �'�'`��''� . . , ,.. .�f ,, . ' ' � '• n;'�S_.i , i s �:r� i i '-�e i �Jl�Tr�...r �. , , ; , aly: , G'ari�ic/,.. � ..� ziP: . �D���d?.»n .,.� ., .. : ��� _ .�. . . � ' ,.}.c r ��ni� R � . q: �' : . 5 a 1�r.� �. 1.. � .f�� F ,;4 ' /�` � � 1 . Ayailability ?aid:.._ ' � ' Conneclion Fee Paid 7✓d���-�` a��`����� ' � �. � . . ���r :� . � � � > : _ ,, � , ,,ir 3 i . . � :�, r - • . Y'a � .c„� � � -. " c . ...� . • Interceptor Charges Paid: � � Surchaiges:' � � �.•:„ -� � _a•.., F < �._a: . , � . i'�, . '^ . . � .. - . � . •: �r5� � .`... ,� v t'v�. , � �A i:,µK q .�''+y�rt'� � , " _ � . . .. �( i � � • , . roh�a ,s'v�J F Y �y • •: • . F. � ,' .Il yvlf Y 1 \ � � . . � _ PLEASE NOTE: Installalion of bufld(ng sewer shall be per the.specfflcetlons b� 1he,Clay '. Townsfilp Regional Waste District (seewreverse):All installatwns sfiell be,lnspected,byl.bistrict ' � - - personnel during "open�irench" phase and be�ore backfill(ng willi sand o`r stone lo�$ix inches , . � above the pipe NQ footing o�-foundation d�ain'sr or other sources o�ground or slormw�ie�;;shall � be permitJed to enter the Distnct s sanilary sewer sysiem Tfie Disl�lcl wili �ssume ao ��ab��i{y for '; i - � drains which are tielow the grade level of�the nearesl downst�eam manholeFnoh�or(����$I�!'wh(ch Y ' , ` are eztended beneath 8iiveways or s(dew9lks Tlie permit fiolder,(property owner,�d�Vglober or , ;�� � builder) will be responsible., For damages�to lhe.District'"s sewer`s system inc�ildin� ?n��holes,. castings„manhole dids and the like, cause� �y.conslrucLon adlwly on the buildin� sH��4lilch is ' Y the subjecl of this perinit, the permit holtler is`aiso Fesponsible j , �' ;i`��'' ; ` .. e -`.'-� _, � . '•"' " }hb �� : 9 i '� '. g � e . fiF. tp� � . . �i � ' � Inspeclions by the District are MANDATORY ani) shall tie arranged 6y contaoling l{�� bi`sliid s � • officelat;e44-9200 one�to fouc hou�s In advahce<AI� new;con"st�r`ucilon will 6e pleced o�i blllin� s�z. - r, .. _ i°.... . . : . . . 'a�:�': Y �N.PI 4:��y?� ;. . 1 � 7�t.;., a . ,-� �.. +, S� � ��`� I� . ' months!after connection has,been made , � , . , ; ,,,, � � ,. . � , . , '. 7 _. � ' .� � 1t �J, . 6.,�� ^er.+ n C':d:.`.� r'w u•p1�� � . . By signirig below I attest that I am famillar wRh;tfie Distiicl's specificaUons and a�ree �o.accept .. , . .,.. , .responsibililyforall_work,doneundec,lfiispermit ;: . - ` � . ' s , ,��.•� . ' � /�X�/� �J�.�� �'Y� .� Fi I : .y' ,,,, ,�,t�f 1�{�� : i. t � ?', M I ` a .�'.d BuildedOwne�Signaluie ,J�� Phon �� ; ; TO,yc ,,,, 0 _ Inspection Fee Pald:_ �_, i/ . �slte pla �6mlNed . G� . . :. ... . . . . . . ' .ir .y ,. •' ' .. 1� . � t; . U, L` "., Permit issued tfiis .�day of . `�"199 .• • C���� m � , � ' V � .i � � f �. . i � t ^' � � � O), Jay W..Alley, Utility Manage� 4 ? " �Sy�. . �,Sti� , . . ' p�'G1Q11*1,� ' . . . _ ,. Perriiit valid only witfi CTRIND seal in`ied.ink. • . . , , , . . .IN:��-0�.�CI� . . t . �,��� . � :�, 1