To the Village of Millstadt:
A. THE UNDERSIGNED, being the (Owner, Owner's Agent)
DOES HEREBY REQUEST a permit to install sanitary sewage disposal facilities to serve the (Residence, Commercial Building, etc.) at said location.
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.
3. The name and address of the person or firm who will perform the work 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 said 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 Village.
2. To accept and abide by all provisions of the Municipal Code, of the Village of Millstadt, 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 sanitary manner at all times, in compliance with all requirements of the Village and at no expense to the Village.