HomeMy Public PortalAbout6400 BARELA AVE_Sewer__ ""GA= APPLICATION FOR PERMIT 1
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REGISTRATION N0. COUSTATNTY MANHOLE REFERENCE ,�f UPPER
RE DESCRIPTION 7 LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWE31
SEPTIC TAlMX.SEEPAGE PIT ORTYPE OF ON LENGTH FROM
PITS AND/OR DRAINFIELD 3.00 T. P.L. M.L.TO P.L-
OVERFLOW SEtPAGE PIT,DRAJKF19LD
]=N. CESSP00 DRYWELL----E 2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM 1.00 CO.IMF.No. JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER 1.00 TRUNK PERMIT X0. ROAD PERMIT X0.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 1.00 STATE ENCROACHMENT
PERRIT N0.
INDUSTRIAL
WAST9 APPROVAL
- CHARGED
OVMOn PERMT 00 CONNECTION CHARGE FEE
AUTHOEIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT ATE A CONTRACT WITH THE HER.EfN NAMED C-Olq-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPEOVAM DATE IXSP R'S SIG URE
TO THE PUBLIC SEWER.
SIGNED THIS nAY 0 1 9 NEW HOUSE SEWER E ' _
OWNER OR --
.rONNECT ADDITIONAL
OWNERS AGmm 'v_' BUILDING OR WORK
ADDRESS SEPTIC TANK,BEEP,PIT{S)AXD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAV[ READ PHIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND-AGREE TO COMPLY CESSPOOL El DRTWELL
WITH ALL COUNTY ORDINANCES MD STATE LAWS REGULATING ALTER.REFAIR,SEWER OR
PLUIBI AAD SEWERS, SEWAGE DISPOSAL SYSTEM -
1 THAT I 711 PERLT REGISTERED AND70R
LI ASETNT
T BTLOSLES COUNTY AND STATE OFDISCONNECT PLUG ANDCA AN LA 1 A GAL OWNER OF THE-ASOYE ABANDON HOUSESEWER
D BACKFILL S C TANKS
SIGNATURE SEEP.PITS CESSPOOLS
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