DEPARTMENT OF PUBLIC SERVICE Division of Engineering DISTRICT STORM DRAINAGE SEWER PERMIT NO. VOID 1 YEAR FROM DATE DISTRICT Permission is hereby granted to to connect premises located at Lot Blk. Addition with the main Sewer located in Street, said applicant in accepting this permit agrees in consideration of the rights and privileges granted: (1) To hold the City harmless for any loss or damage that may in any way result from or be occasioned by such connection: (2) That said owner shall maintain said connection or sewer in a serviceable condition from the building to the Tee, 'Y', or Tap in the main sewer, all at his own cost and expense: (3) That any part where deemed in public interest, be appropriated by the City as a public sewer; (4) That the use and construction of said connection or sewer shall be subject to and in conformance with all regulations and conditions set forth in City Ordinances controlling the use and construction of District Area Storm Drainage facilities. Permit charges due and payable prior to issuance of permit: Sewer Permit Fee Tap-In and Service Charge (Calculations on reverse side) Deferred Assessment Charge (Calculations on reverse side) Pavement Opening Deposit Permit Issued on ,198 Deposit Refunded ,198 Other Charges (See reverse side) TOTAL CHARGES Licensed Sewer Contractor (authorized by the Owner) (Licensed Contractor) Permit Issued Date Signed (City Engineer) Copy forwarded to the Director of Utilities (Date) (Ord. 19-91. Passed 3-18-91.) |