(A) Residential or commercial building sewer application.
A. The UNDERSIGNED, being ___________ property located at ___________________________ ___________________________. DOES HEREBY REQUEST a permit to install and connect a building sewer to serve the ______________________________ at said location.
1. The following indicated fixtures will be connected to the proposed building sewer:
NUMBER FIXTURES NUMBER FIXTURES
_________ Kitchen Sinks _________ Water Closets
_________ Lavatories __________ Bath Tubs
_________ Laundry Tubs _________ Showers
_________ Garbage Grinders __________ Urinals
Specify other fixtures: ________________________________________________________
2. A maximum of ____________________________________ people will use these fixtures.
3. The name and address of the person or firm who will perform the work is _________ ______________________________________________________________________________.
4. Plans and specifications for the proposed building sewer are attached hereto.
B. In consideration of the granting of this permit, THE UNDERSIGNED AGREES:
1. To accept and abide by all provisions of the Village Code of the Village of Herrick, and of all other pertinent ordinances or regulations that may be adopted in the future;
2. To maintain the building sewer at no expense to the Village of Herrick; and
3. To notify the Village of Herrick when the building sewer is ready for inspection and connection to the public sewer, but before any portion of the work is covered.
DATE:_________________ SIGNED:______________________________________________
______________________________________________
Address of Applicant
$_________ Connection fee paid; $_____________ Inspection fee paid
Permit issued ___________________; __________________________________________________
Village Official
(B) Private sewage disposal application.
A. The UNDERSIGNED, being the __________ property located at ___________________________ ___________________________. DOES HEREBY REQUEST a permit to install sanitary sewage disposal facilities to serve the ______________________________ at said location.
1. The proposed facilities include: _____________________________________, which is to be built in complete accordance with the plans and specifications attached hereto.
2. The area of the property is ___________________________square feet.
3. The name and address of the person or firm who will perform the work is ________________.
4. A maximum of _________________ persons will use the above facility.
5. The locations and nature of all sources of all private and public water supplies within one hundred feet of any boundary of the property are as shown on the plat attached hereto.
B. In consideration of the granting of this permit, THE UNDERSIGNED AGREES:
1. To furnish any additional information relating to the project that is requested by the Village of Herrick;
2. To accept and abide by all provisions of the Village Code of the Village of Herrick, and of all other pertinent ordinances or regulations that may be adopted in the future;
3. To operate and maintain the wastewater disposal facilities covered by this application in a sanitary manner at all times, in compliance with all requirements of the Village of Herrick and at no expense to the Village of Herrick; and
4. To notify the Village of Herrick at least twenty-four hours prior to commencement and again at least twenty-four hours prior to the covering of any portions of the installation.
DATE:_______________ SIGNED: _______________________________________________
_______________________________________________
Address of Applicant
$ ______________ Inspection fee paid.
Permit issued this ___________________; ___________________________________________
Village Official
(Ord. 153, passed 7-9-1990)