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CITY OF - Application For Permit To Connect To Water And/Or Sewer

The document is an application for a permit to connect a property to the City of _________ water and/or sewer systems. It provides details of the property such as the lot, block, and subdivision. It states that the applicant is aware they must apply at least 10 days before the desired connection date and pay connection fees. The applicant also acknowledges they are responsible for following city ordinances and policies regarding utility connections and paying any additional costs incurred.

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Anand Raj
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18 views

CITY OF - Application For Permit To Connect To Water And/Or Sewer

The document is an application for a permit to connect a property to the City of _________ water and/or sewer systems. It provides details of the property such as the lot, block, and subdivision. It states that the applicant is aware they must apply at least 10 days before the desired connection date and pay connection fees. The applicant also acknowledges they are responsible for following city ordinances and policies regarding utility connections and paying any additional costs incurred.

Uploaded by

Anand Raj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CITY OF _________

APPLICATION FOR PERMIT TO CONNECT TO


WATER AND/OR SEWER
The undersigned hereby makes application to connect the premises located on the following
described property with the City of _________ water and/or sewer:
Lot and/or Lots _______________________ in Block ____________________________
Subdivision__________________________in the City of __________, Minnesota.
The address of said premises is: ______________________________________________
The applicant states that he/she is the owner of said property and will be liable for conforming to
ordinances and policies of the City of __________ pertaining to the use of public water and/or sewer
and the connection thereto.
The applicant further states that he/she is aware application for permit to connect to City or
__________ water and/or sewer shall be made at least ten (10) days prior to the date such connection
is desired. Payment of $__________ for water connection and/or $_________ for sewer connection
shall be made in advance, together with the application. Any backhoe or other digging fees and
street restoration costs incurred, including bituminous, related to the utility connection, as well as
any additional costs related to oversize lines installed and/or meter required for oversize lines are to
be paid by the applicant. All work is subject to the approval of the City of __________ Public
Works Department, who shall be notified by the applicant so that the work may be inspected and
approved as provided by ordinance.

_______________________________________________
Applicant Signature

_________________
Date

RECORD OF WATER AND/OR SEWER CONNECTION


Street Address ______________________________________________________
Materials used / Size ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Location of Sewer ____________________________________________
______________________________________________________________________________

_________________________________________
Inspected by

___________________
Date

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