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APPLICATION FOR A PLUMBING PERMIT

APPLICATION DATES

I/We hereby make application and provide plans under the provisions of the
pertinent Bylaws for permission to conatruct, repair or alter the following
pbuilding or structure and agree to comply with all the requirements of the
said Bylaws and to indemnify and keep harmless the City againat all claims,
liabilities, judgements, coats and expenses of whatever kind, which may in any
way accrue ageaineat the said City in consequence of, and incidental to, the

granting of this Permit, if issued.

BUILDING SITE ADDRESS:

PARTIAL LEGAL DESCRIPTION: Lot #

ONER

Name

Address

City

Postal Code | Telephone/Fax

Manhole(s):
Interceptor(s)
Catch Basin(s)

Lawn Drain(s)

Fire Hydrant(s)
Sandtrapsa

Pump Chambers

Rain Water Leader(s)

PHRARAPNAANERIAR RRA ERR LEAR RARER

*OFFICE USE ONLY

*Permit No. :.
x

®

*Fee Paid:
*

*Receipt: Bi _ oC)
*

*Conments :
*

*
% . ‘ | ‘ .
HARIRI RR ERE AERN LINE REEL NA

(ies. | 2aGe

Address

City

Postal Code Telephone/Fax

| Meters of Pipe

Water Main
Sanitary Sewer
Storm Sewer
Lawn Drain(s)
Sump (s)

Trench Drain(s)

We do not. plan review at
counter. Incomplete drawings
delay your permit application.
signature acknowledges
acceptance of this policy..

Signature

Telephone/Fax