To the City of ________________________________________________________________ : The undersigned being the of the (Owner, Lessee, Tenant, etc.) property located at does hereby request a permit to an industrial (Install, Use) sewer connection serving the , which company is engaged in at said location. 1. A plat of the property showing accurately all sewers and drains now existing is attached hereunto as Exhibit "A". 2. Plans and specifications covering any work proposed to be performed under this permit is attached hereunto as Exhibit "B". 3. A complete schedule of all process waters and industrial wastes produced or expected to be produced at said property, including a description of the character of each waste, the daily volume and maximum rates of discharge, and representative analyses is attached hereunto as Exhibit "C". 4. Triplicate copies of Industrial Waste Questionnaire (913.153 ). 5. The name and address of the person or firm who will perform the work covered by this permit is In consideration of the granting of this permit the undersigned agrees: 1. To furnish any additional information relating to the installation or use of the industrial sewer for which this permit is sought as may be requested by the (Superintendent of Sewage Works). 2. To accept and abide by all provisions of Ordinance No. of the (City of ), and of all other pertinent ordinances or regulations that may be adopted in the future. 3. To operate and maintain any waste pretreatment facilities, as may be required as a condition of the acceptance into the public sewer of the industrial wastes involved, in an efficient manner at all times, and at no expense of the (City). 4. To cooperate at all times with the (Superintendent of Sewage Works) and his representatives in their inspecting, sampling, and study of the industrial wastes, and any facilities provided for pretreatment. 5. To notify the (Superintendent of Sewage Works) immediately in the event of any accident, negligence, or other occurrence that occasions discharge to the public sewers of any wastes of process waters not covered by this permit. Date: Signed (Applicant) (Address of Applicant) Applicant approved and permit granted: Date: Signed (City Engineer) Date: Signed (Plumbing Inspector) (Ord. 19-91. Passed 3-18-91.) |