HomeMy Public PortalAboutSanitary Sewer Connection Permit Form
City of Riverdale, Iowa 110 Manor Drive, Riverdale, Iowa 52722 • (563) 355-2511 • www.riverdaleia.org
CITY OF RIVERDALE, IOWA
SANITARY SEWER APPLICATION & PERMIT FORM
PROJECT INFORMATION
Project Address
Subdivision
Lot #
Owner Name
Owner Phone
INTENDED USE INTENDED SIZE NUMBER OF CONNECTIONS
☐ Residential Number of Rooms Public Sewer System
☐ Commercial Number of Dwelling Units Private Sewer System
☐ Industrial Square Footage FEE: $25
PLUMBING CONTRACTOR INFORMATION
Company
Phone
Email
MATERIAL
☐ Clay ☐ Concrete ☐ Cast Iron ☐ Ductile Iron ☐ PVC: ☐4" ☐ 6" ☐ 8"
EXCAVATION LOCATION
☐ Street ☐ Alley ☐ Easement ☐ Lot
Determine location of wye-branch before commencing excavation. Existing septic tanks must be sterilized,
plugged, and filled.
APPLICANT INFORMATION
Name
Phone
Email
Signature
City of Riverdale, Iowa 110 Manor Drive, Riverdale, Iowa 52722 • (563) 355-2511 • www.riverdaleia.org
Submit this form and attachments to:
Operations Manager, Public Works Department
City of Riverdale, Iowa
110 Manor Drive, Riverdale, IA 52722
operations@riverdaleia.org
(563) 949-0464
FOR OFFICE USE ONLY
Fee Received ☐ Yes ☐ No Permit Issued ☐ Yes ☐ No
Processed By Permit Number
City of Riverdale, Iowa 110 Manor Drive, Riverdale, Iowa 52722 • (563) 355-2511 • www.riverdaleia.org
City of Riverdale, Iowa 110 Manor Drive, Riverdale, Iowa 52722 • (563) 355-2511 • www.riverdaleia.org