Gravity house connection drawing submission, Jan 1984

NYC 9/11 Public Portal Document

rit^H>»AY~~Tl'RklT NUMBER BLOCK I For* Mo. Wpc-8 bv. t (12-77) [Tellow]

THIS IS NOT AN APPLIO •JION 'rd OPEN THE STREET OR SIDEWALK. THE. C I TTY OF N E ‘ W'- YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU . OF HATER POLLUTION CONTROL

BOROUGH OF

APPLICATION -F6R PERMIT TO INSTALL SIWGLE/MOLT'IPLE PREniSE(S) SEJ^R HOUSE CONNECT I ON (S) APPLICATION IS HEREBY MADE.FOR. PERMISSION TO CONNECT THE FOLLOWING HOUSES TO THE EXISTING .____ .PRIVATE i ,■ CITY SANITARY ^STORM COMBINED SEWER(S) LOCATED IN (Check one of the above'.')' (Check, one or more of ■ the above.)

/ / CONSENT FROM OWNER.(S) OF- • V 1 > PRIVATE SEWER FURRISHED. . (Street' Hatae).

BETWEEN and. 3^^sjT ^^GC) N

- ..THfeYQWNER OR-BUILDER OF THE BUILDING_(V)_ IS

address of tHe owner or builder is 4 4<-4-ns u HOUSE 'NO- N.B. NO. LOT NO. ' CONN SIZE(S) A TYPE(S) . LOCATION* PERMIT NO

\\ - □ri VI ■■

‘Indicate side of street (K,S,E or t/) and the distance front the building line on the corner of either '' intersecting' street to'the first building line of the ■ structure •'here wop* la^tp^tK^dqne. • ; IJ IS .UNDERSTOOD AND AGREED .THAT THE'WORK PROPOSED •SHAtt''WE EXECUTED Hi >' COOD'^AND WORKMAN-LIKE BANNER AND TO THE SATISFACTION OF THE COMMISSIONER, IN ACCORDANCE WITH THE PROVISIONS'OF THE ADMINISTRATIVE CODE OF THE CITY OF NEW YORK AND ANY AMENDMENTS THERETO, AND ANY APPLICABLE RULES AND REGULATIONS.

NAME OF THE LICENSED PLUMBER (Print)

SIGNATURE OF THE LICENSED PLUMBER

ADDRESS OF THE LICENSED PLUMBER PLUMBER'S LICENSE NUMBER E. jq Sr_______

BUREAU OF WATER POLLUTION CONTP.OL Cctnmtnii- and A.pphova( Stamp PERMIT FEE $ DATE

I. The sewer(s) to which the house connection(s) is/are made, is/are / / is/are not / 7 conne privat treatment plant. This private treatment plant discharges / / does not discharge / / to the City sewer system.

2. Number of premises indicated Tot a 1' ■ number of connectjon.s Indicated

TO THE PLUMBER; ALL HOUSE CONNECTION DRAINS TO BE GRAVITY LINES ONLY.

A/o The permit, is ... . .valid for thirty CITY OF NEW YORK DEPT. OF ENVin. PROT. (30) days BUREAU OF SEWERS PERMIT CONTROL SECTION i - APPROVED , , J BV>$Z4^ C.,.n. DATE'.^^fo APPPOVAl VALW TOK THLKTV liO]'v(ys. WTE:

FILL IN PERMIT NUMBERS ABOVE. TOTAL FEE PAID S

DATE: CLERK ------ ----------------------- :------ ' ' ' ~ _______________ . bUKEkU OF ttftTEK. .KEGISTER______________ NO PERMIT(S) OF ANY TYPE WILL BE ISSUED FROM THE BUREAU OF HATER REGISTER UNTIL ALL OPEN CHARGES HAVE BEEN PAID AND ALL KNOWN VIOLATIONS AGAINST THE PREMISES HAVE BEEK REMOVED TO THE SATISFACTION OF THE DEPARTMENT.

N YC-WT C_000165060