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PLUMBING PERMIT, TYPE: O8-SITE SERVICES

APPLICATION DATE PERMYT NOQ.

This permit is issued to the Owner/Agent named below, for the purpose of
the plumbing or related work described herein. The validity of this
permit 48 subject to compliance with the plans and other documents
submitted with the permit application, and to the compliance with the

"Building and Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS

LOT ZONING

QHMER

Name Name

Address Address

City City

Postal Code Talephone  Poatal Code Telephone

SIGNATURE OF NAME
OWNER / AGENT, TELEPHONE

NOTES

PERMIT FEES:

On-Site Services Manhole(s)
Interceptor(s)

Catch Basin(s)

Lawn Drain(s)
Water Main Metres of Pipe
Sanitary Sewer Metres of Pipe
Storm Sewer Metres of Pipe
Fire Hydrant Fire Hydrant(s)
Other Specify

TOTAL FRES!

THE ISSUANCE OF THIS PERMIT SHALL IN NO CASE BE TAREN AS ASSUMPTION OF
RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES, STATUTES OR

BYLAWS

BUILDING DATE
OFFICIAL ISSUFP yy

2735
25