HomeMy WebLinkAboutPermit Wastewater Connection WW-12-4153 Permit Number WW-
City of South Burlington, Vermont
Application for Wastewater Connection
Property Owner: jo/ 'i 1t�j ` om ''tun to S LL Phone: . 1 o 6
Address:
S. U � v o Sc/03
Applicant: s V,t1414 ( MnA,LI {-us L-L.c:-_ Phone: 6cr.-6 2..b
Address: Po 6 z);( Z Z 3)41 -(0 004 (C.)
Project Location: 30 . I/t(U 4 V
idential ❑Commercial ❑ On-Site Septic
Person or firm doing the work: I rel eArk Phone: w��"��/
Address: po QD x .2-gig
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Sketch of Sewer Connection(For Inspector Use Only): 5
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In consideration of the granting of this permit,the undersigned agrees:
I. 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 he 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 appointnleuk
Applicant Signature: Date: 5-1/
Inspection Fee:
Recording Fee: r
Application: ❑Rejected p / /%�
Code Officer Signature: Date: /
Date of Inspection: ►/ZV 1I Z I
Inspector's Signature: pro-acre /1/&N-s-41-7,
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