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.) |