To the of _____________________
A. The undersigned, being the _____________________________________
(Owner, Owner's Agent)
property located at ______________________________________________
(Address)
DOES HEREBY REQUEST a permit to install and connect a building to serve the
________________________ at the location.
(Residence)
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. The maximum number of persons who will use the above fixture is _________ .
3. The name and address of the person or firm who will perform the proposed work is .
4. Plans and specifications for the proposed building sewer are attached hereunto as Exhibit “A.”
B. In consideration of the granting of this permit, THE UNDERSIGNED AGREES:
1. To accept and abide by all provisions of the Applicable Codes of the city of Lockport, and of all the pertinent ordinances or regulations that may be adopted in the future.
2. To maintain the building sewer at no expense to the city.
3. To notify the Lockport Waterworks and Sewerage System and/or Plumbing Inspector 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: ___________________
(Applicant)
___________________
___________________
(Address of Applicant)
(Certification by , Treasurer)
$ Connection fee paid.
$ Inspection fee paid.
Application approved and
permit issued: Signed
(Approving Authority)
(Ord. 1097, passed 11-16-87)