HomeMy WebLinkAboutPermit Wastewater Connection WW-06-3902 Alfa-12-20 09:5 P FROM:CITY OF SOUTH OURLIN 8028464101 TO:96587976 F,i.
Permit Number WW-
City of South Burlington, Vermont
Application for Wastewater Connection
Property Own .r: t;5. "7R1i5- �b-/4,r�hrti�Li:" ,,� Phone: _.Z
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Address: / a( 'r tll �o/�,r
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Applicant; , 'Q ,1;4i,j ~— __ ______ Phone: "a - 41 4
Address: I_ . / Qbc. pet t4� 7"67&"A� /Dip w,
Project Locriti in:jt3 r .ic Vez:
0 Residential ornm-rcial Q On-Site Septic
Person or fin doing the work:di ,._ yUitnv� Phone:_
Address.__ 4 NGL. dl
Sketch of Se r Connection(For Inspector Use Only)
4ex-" ram-. s aCr y'�[r•{ U �. 61ledifs C3
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FCCA51 Pja7s5.
In consideration of a granting of this permit,the undersigned agrees:
I. To accept and hide by all provisions of the Sewer Ordinance,as from time to time amended,ot'tho City of aouCt Burlington,
and ell otherp -inent ordinances or regulation that may be adopted in the future.
? To maintain building sewer at no expense to the City.
3, To notify the t apartment of Public Works when the sewer is randy for inspection and connection to the public sewer Wore any
potilon of the oak is covered.
4. To notify the :-partmentsQr'Abbe at Ieasttw dap in advance of the requested time far sewer inspection.
Ca)1658-7961 or an appointment
Applicant Si attire: � Date: /2--D.s"'C'C
Inspection F:•:_ ,L
Recording F: :__
Application: Q Rejected I n • t
Code Officer •ignature: �"% / _-+ Date !/
Date of I.nsl► tion: /v2 - /9 •-o?c'fv / ,
Inspector's S'; afire:
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