HomeMy Public PortalAboutPERMIT APPLICATION: Sanitary Sewer Connection
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: $50
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