HomeMy WebLinkAboutPermit Wastewater Connection WW-00-0000 Permit Number WW- -
City of South Burlington, Vermont
Application for Wastewater Connection
Property Owner: Phone:
Address:
Applicant: Phone:
Address:
Project Location: 1 Y` fn.( 1 t -4,1 , 1 rk rte..,
❑ Residential ❑ Commercial ❑ On-Site Septic
Person or firm doing the work: Phone:
Address:
Sketch of Sewer Connection(For Inspector Use Only):
T YE ou ArTeR. 33o vnek
/
/ 45° ELar,t,./
6 ' `I
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22'ECBokI N
f
firs
24((t ,> 4 r) L,4J.L C., 1,/T S
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 firture.
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: Seri / z,
Inspector's Signature: %1,Q.,C )--