913.025A RESIDENTIAL OR COMMERCIAL BUILDING SEWER APPLICATION.
 
CLASS OF PERMIT                                                                       
The city of _____________________________________________________________ :
The undersigned, being the ____________________________________________ of the
             (Owner, Owner's Agent)
property located at ___________________________________________________ , does
         (Number)       (Street)
hereby request a permit to install and connect a building sewer to serve the
                                                                                      at said location.
      (Residence, Commercial Building, etc.)
1.    The following indicated fixtures will be connected to the proposed building sewer:
    Number       Fixture          Number       Fixture
                                      Kitchen sinks                                Water closets
                                      Lavatories                                       Bath tubs
                                      Laundry tubs                                Showers
                                      Urinals                                       Garbage grinders
Specify other fixtures                                                                                                     
2.    The maximum number of persons who will use the above fixtures 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 hereto as Exhibit "A".
   In consideration of the granting of this permit, the undersigned agrees:
1.    To accept and abide by all provisions of the Lorain Codified Ordinances.
2.    To maintain the building sewer at no expense to the (City).
3.    To notify the (City Engineer) when the building sewer is ready for inspection and the connection to the public sewer is completed. The sewer conduit shall remain exposed until inspected and approved. Only approved sections shall be backfilled.
Does the applicant have existing indebtedness to the Division of Utilities? YES         NO          
Date:                                          Signed                                                                        
                         (Applicant)
                                                                                                                
                      (Address of Applicant)
Applicant approved and permit issued:
Date:                                          Signed _______________________ _____
                    City Engineer
Date:                                          Signed                                                    
                   Plumbing Inspector
(Ord. 19-91. Passed 3-18-91.)