Permit # ______ TOWN OF BREMEN SEWER LINE CONSTRUCTION PERMIT Date ______________________ Name of Applicant: ______________________________ Address: _______________________________________ ___________________________________________ Phone Number __________________________________ Address where construction is to take place (if different than above). ______________________________________________________________ Purpose of Construction, Check One – Replacement Sewer Line ________ New Sewer Line ________ Relocate Sewer Line ________ Other (describe) _______________________________________ What size pipe is being constructed or replaced? ________ What type of sewer line material will be used? Plastic ________ (circle one) Sch 35 or Sch 40 Vitrified Pipe ________ Plastic Pressure Pipe ________ (circle one) SDR 26 or SDR 21 Ductile Iron ________ When is Construction Scheduled to Take Place? Date _________________________ Diagram Project, show Streets, lot, Building on Lot and where construction will take place. Use the backside of this form. Date Reviewed __________________ Approved ________ Denied ________ Reason Denied __________________ ______________________________________________________________ By __________________________ For Inspection call 546-4324 |
(Prior Code, Ch. 100)