Gravity house connection drawing submission, Jan 1984

NYC 9/11 Public Portal Document

For lo. ~Ipc-e Nov. B (12-77) •itt AY E T N MB R OCR (Yellow)

OPEN THE STREET OR SIDERALK.. IS NOT AN. AP LICA'1ION tO THIS

_ - - • T H S. C IT"Y 'OP N E , W' • Y 0 R K ENVIRONMENTAL PROTECTION DEPARTMENT OF WATER POLLUTION CONTROL BUREAU OF

BOROUGH OF

APPLICATION -FOR PERMIT

PREMISE(S) 'SEER HOUSE CONNECTION(S) TO INSTALL SINGLE/MULT'IPLE. FOLLOWING HOUSES TO THE EXISTING FOR. PERMISSION TO CONNECT •THE APPLICATION IS HEREBY MADE COMBINED S R(S) LOCATED IN CITY SANITARY STORM PRIVATE . (ChecY, . one or more of the above.) C( heck one of the above.)

CONSENT FROM OWNER.(S;) .OF~ PRIVATE SEWER FURNISHED_ (Street N me) \ii -'J ..AND. BETWEEN

THE BUILDING(S) IS t • '•7HIi OWN.SR OR -BUILDER OF

BUILDER IS I...a ..,„ ADDRESS OF THE OWNER OR

TYPES) LOCATION• PERMIT NO NO. CONN SIZE S) t N.B. NO. LOT HOUSE -NO..

I , ..___ __

building line on the corner of either N) and the distance from the 'Indicate side of street (N,S,E or -the structure where work jsto;lee dgne. building line of intersecting street to the first PROPOSED'SHAL1.'WE'ERECUTSD Ii/`A'COO)) AND WORKMAN-LIKE MANNER AND TO THE AGREED,THAT.THE"WORK I IS .UNDERSTOOD AND ADMINISTRATIVE CODE OF THE CITY OF NEW YORE THE CO)O4ISSIONER, IN ACCORDANCE WITH THE PROVISIONS OF THE SATISFACTION OF ANY APPLICABLE RULESAND_.REGULATIONS._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.__ AND ANY AMENDMENTS THERETO, AND

PLUMBER (Print) NAME OF THE LICENSED

SIGNATLRE. OF THE LICENSED PLUMBER j ADDRESS OF THE LICENSED PLUMBER P PLUMBER'S LICENSE NUMBER

WATER POLLUTION CONTROL BUREAU OF _ DATE: AppAovat Stamp PERMIT FEE $- ~L -y Comments' and /_7 con4ted a privat house connection(s) is/are made, is/are / / is/arc not The sewer(s) to which the treatment plant. system. Y sewer Y es /'I does not discharge / / to the City This private ........................ Totah•niimber of connections indicated indicated 2. Number of premises ONLY. DRAINS TO BE GRAVITY LINES TO THE PLUMBER: ALL HOUSE CONNECTION

O 1GA The permit. -is S A~1D OPE' CITY OF NEW YORK EX4_~~v'~~oI1F(Fo~ " Fovisl N~oI Valid for th irty DEPT. OF ENV~IR.^Pf OT. BUREAU OF ~clt ERS TC t O''''. CGD'c•RU- t1T1O11 (30) days PERMIT CONTROL SECTION I::~~ST , '.AL ClON O- DC p APPROVED /,r.;Y EY ~I Is.00t„rvaEl~ ~)pEFATl O B'Y .. rte-. , DATE• FOR THIRTY 1301 NOTE: APPR0VAL_ VALID

TOTAL FEE PAID $ FILL IN PERMIT NUMBERS ABOVE,

CLERK _ .. . . -. .. DATE: - HATER- ..REGISTER AVREAU OF HAVE REGISTER UNTIL ALL OPEN CRAIIGES BUREAU OP WATER PERMITS) OP ANY TYPE WILL BE ISSUED FROM THE OF THE DEPARTMENT. NO TO THE SATISFACTION PREMISES HAVE BEEN REIfOVED BEEN PAID AND ALL KNOWN VIOLATIONS AGAINST THE

NYC-WTC 000165060