HomeMy WebLinkAboutPermit Wastewater Connection WW-01-3325 Permit Number WW- 0/ - J r 5
City of South Burlington, Vermont
C3plication i*orWastewater Connection
Property Owner: -� .-,� lei Phone: 60 �c(91-6
Address: PG ' , S)
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Applicant: t-c '1 (' Phone:
Address: 'C re-
Project Location: ?� 4f-i, )l f c.,,,,,,� t2,
Residential E Commercial ❑ On-Site Septic
Person or firm doing the work: g-.. t Phone: O& ..P . tv
Address: ` ,//,' S .,;
Sketch of Sewer Connection (For Inspector Use Only):
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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.' blic orks at st tw (2)w.. 'u_ ys in adv.. - , equested time for s insp ion.
Call 658-7961 for an appoi man �
Applicant Signature: _—<C _ Date: `4/ e)
Inspection Fee: ��,,��
Recording Fee: /a
Application: ❑ Rejected, - / C_ d e
Code Officer Signature: .4c Date: `7 1)
Date of Inspection: �>--2 ; (.:,1 �
Inspector's Signature: *l am' �{
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