To the city of Lockport:
A.   THE UNDERSIGNED, being the ________________________
                     (Owner, Owner's Agent)
of the property located at _____________________________________
DOES HEREBY REQUEST a permit to install sanitary sewage disposal facilities to serve the______________________                                     at the location.
      (Residence, Commercial Building, etc.)
1.   The proposed facilities include: __________                       to be constructed in complete accordance with the plans and specifications attached hereunto as Exhibit “A.”
2.   The area of the property is        square feet (or       square meters).
3.   The name and address of the person to be served by the proposed facilities is: _______________ .
4.   The maximum number of persons to be served by the proposed facilities is: _______                          .
5.   The locations and nature of all sources of private or public water supply within the one hundred (100) feet (30.5 meters) of any boundary of the property are shown on the plat attached hereunto as Exhibit “B.”
B.   In consideration of the granting of this permit, THE UNDERSIGNED AGREES:
1.   To furnish any additional information relating to the proposed work that shall be requested by the city of Lockport.
2.   To accept and abide by all provisions of the City Code, of the city of Lockport, 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 city and at no expense to the city.
4.   To notify the Lockport Waterworks and Sewerage System and/or Plumbing Inspector at least twenty-four (24) hours prior to commencement of the work proposed, and again at least twenty-four (24) hours prior to the covering of any underground portions of the installation.
DATE: ________________
SIGNED: __________________   _________________________
    (Applicant)        Address of Applicant
$ Inspection fee paid.
(Certification by City Treasurer)
Application approved and permit issued:
(Ord. 1097, passed 11-16-87)