It is hereby certified that inspection has been made of the individually-owned sewer mains and sanitary service connection for the property described below by both the village and SCWRD, and said installation is hereby approved as in compliance with the specifications, rules and regulations established by the revised code of this municipality.
Permission is hereby granted to complete the construction of said individually-owned sewer main to the village sanitary sewerage system and to utilize the same for waste disposal in compliance at all times, with the revised code of this village.
NO. _________________________________________
ADDRESS: ___________________________________
TYPE OF CONNECTION:
_________________ Single-family residence
_________________ Multiple dwelling or trailer court
_________________ Commercial
_________________ Industrial
_________________ Institutional
_________________ Governmental
INSTALLATION BY: _____________________________________________________________
THE SERVICE IS IN OPERATION AS OF THIS _______ DAY OF ________, 20_______.
VILLAGE OF ROCHESTER
COUNTY OF SANGAMON
SIGNED: _________________________________