HomeMy WebLinkAboutPermit Wastewater Connection WW-22-56Permit Number WW-______-__________
City of South Burlington, Vermont
Application for Wastewater Connection
Property Owner:_________________________________________ Phone:___________
Address:_______________________________________________
_______________________________________________
Applicant:______________________________________________ Phone:___________
Address:_______________________________________________
_______________________________________________
Project Location:________________________________________
Residential Commercial On-Site Septic
Person or firm doing the work:______________________________ Phone:__________
Address:_______________________________________________
________________________________________________
Sketch of Sewer Connection (For Inspector Use Only):
In consideration of the granting of this permit, the undersigned agrees:
1. To accept and abide by all provisions of the Sewer Ordinance, as from time to time amended, of the City of South Burlington,
and all other pertinent ordinances or regulations that may be adopted in the future.
2. To maintain the building sewer at no expense to the City.
3. To notify the Department of Public Works when the sewer is ready for inspection and connection to the public sewer before any
portion of the work is covered.
4. To notify the Department of Public Works at least two (2) working days in advance of the requested time for sewer inspection.
Call 658-7961 for an appointment.
Applicant Signature:___________________________________ Date:_______________
Inspection Fee:_______________
Recording Fee:_______________
Application: Rejected Approved
Code Officer Signature:________________________________ Date:_______________
Date of Inspection:__________________
Inspector’s Signature:_____________________________________________
22 56
XX $50.00
$13.00
12/09/2022