To the Municipality of Dublin, Ohio:
The undersigned being the ______________________________________
(owner, lessee, tenant, etc.)
of the property located at ____________________________________________
does hereby request a permit to__________________ an industrial sewer connection
(install, use)
serving the ___________________________________________, which company
(name of company)
is engaged in ____________________________________________________
at said location.
1. A plan of the property showing accurately all sewers and drains now existing is attached hereunto as Exhibit "A".
2. Plans and specifications covering any work proposed to be performed under this permit is attached hereunto as Exhibit "B".
3. a complete schedule of all process waters and industrial wastes produced or expected to be produced at said property, including a description of the character of each waste, the daily volume and maximum rates of discharge, and representative, analyses, is attached hereunto as Exhibit "C".
4. The name and address of the person or firm who will perform the work covered by this permit is .
In consideration of the granting of this permit the undersigned agrees:
1. To furnish any additional information relating to the installation or use of the industrial sewer for which this permit is sought as may be requested by the superintendent.
2. To accept and abide by all provisions of the Municipality of Dublin, Ohio and of all other pertinent ordinances or regulations that may be adopted in the future.
3. To operate and maintain any waste pretreatment facilities, as may be required as a condition of the acceptance into the public sewer of the industrial wastes involved, in an efficient manner at all times, and at no expense to the municipality.
4. To cooperate at all times with the Superintendent and his representatives in their inspecting, sampling, and study of the industrial wastes, and any facilities provided for pretreatment.
5. To notify the Superintendent immediately in the event of any accident, negligence, or other occurrence that occasions discharge to the public sewers of any wastes or process waters not covered by this permit.
Date: ______________ Signed ___________________________
(applicant)
________________________
(address of applicant)
Applicant approved: ________________________
Applicant approved: ________________________
Date: ___________________ _____________________________
(certification by Clerk)
(certification by Clerk)
Signed __________________________
(Superintendent)
('80 Code, Ch. 921, Appendix C) (Ord. 59-74, passed 11-18-74)