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Village of Lithe Canada C)-(5 <br />Re/.4/51.. N2 216 <br />/d'7 Permit for Sewer Service Connection <br />/ °7,74– BY VILLAGE Date <br />GAL DESCRIPTION:...__ <br />ADDRESS 9 nrr <br />DNTRACTOR �'L!1Sr �'r ^.8.t - •• ADDRESS <br />,gyp. _._� <br />Action on Applications (/ <br />1RVICE or WYE LOCATION <br />Nature of Bldg. <br />L9/ <br />— (Distance from nearest downstream manhole) <br />ITEM: <br />- ILLAGE PROPERTY: <br />APPROVED <br />DATE <br />REMARKS — MATERIAL USED <br />I. WYE in Main <br />2. Main to Property Line <br />3. Street Permit <br />PRIVATE PROPERTY: <br />I. Inside Plumbing <br />2. Outside Service Connection Completed <br />SKETCH: (Show North, Street and Property Line and Ties, <br />Location of Weil, Unfilled Septic Tanks and Dry Wells) <br />tt <br />trdet <br />HOUSE <br />� /Lwc <br />All Wooden and Metal Cesspools and Septic Tanks must be filled. <br />Concrete Tanks must be filled if the sewer connection goes over them. <br />NO REFUNDS WILL BE GIVEN I <br />Information on Well for Service Charge: <br />Well Size in <br />Well Depth /.0 ft. <br />Static Water Level ft. <br />Make of Pump <br />Model Number <br />Type of Pump _...._ <br />Motor H.P. %...2 -- <br />Addn'l Info. _. _..._ <br />RATED PUMP CAPACITY <br />a /40 p s i GPM <br />M EQUIVALENT WATER SERVICE <br />SIZE OF WATER METER (if no well) <br />Service Recorded: <br />Signed <br />Page 12 <br />for the Village of Little Canada <br />39.'. <br />