Gravity house connection drawing submission, Jan 1984

NYC 9/11 Public Portal Document Mo. wrc-8 Rev. £ a2! low} - . THE STREET TCAYION TO APPL OPEN OR SIDEWALK. ee = . en THE ciTyY oF REW TORK : DEPARTMENT or ENVIRONMENTAL PROTECTION BUREAU OF WATER POLLUTION CONTROL z ’ 2 , BOROUGH OF i ra L “os "APPLICATION FOR PERMIT i T0 INSTALL SIMGLE/MULTIPLE PREMISE(S):. -SEFER HOUSE CONNECTION(S) APPLICATION IS HEREBY MADE FOR PERMISSION TO: comes FOLLOWING HOUSES TO THE EXISTING PRIVATE city SANITARY > STORM COMBINED SEWER(S) LOCATED IN —=—_——— —_———— — (Check one of the above.) (Check one or ‘more of the above.) “f 7 CONSENT FROM OWNER(S) OF \Q Awré ; — 1 PRIVATE SEWER FURNISHED. —_—_— BETWEEN ah ST 2S ‘ THE OWNER OR BUILDER OF: THE BUILDING(S) Is Ae<-493 \VASt ADDRESS OF THE OWNER OR BUILDER Is (Street Name) AND oe Se HOUSE _NO; N.B. NO. ‘ LOT NO. com SES EIEIO GAS Ar Te fe gees -4\o — iS 115%) 1 Ks ]-2G tho 3* Se a . wr Ace KO 13%) 1, 30537 yaa - hod \ : zy i aA : ‘ f 24 Hegnd x &oa' XY " 1- 24°64 is oo» 7 Ve ra a [-2436, \y ; 10990 s | i, Ne a . re 7 l * * ' *indicate side of street {N,S,E or w)f aad @istance fro ‘the building Bp te] Or! ph; ZANT . t to the first A food, line ‘of the structure where work 15 to ENT ASE or . . IT 1S UNDERSTOOD AND AGREED THAT THE WORK PROPOSED SHALL BE EXECUTED 1n A GOOD AND WORKMAN-LIKE MANNER AND TO THE SATISFACTION OF THE COMMISSIONER, IR ACCORDANCE WLTH Ee ommatis £2.08. .F THE ADMINISTRATIVE CODE OF THE CITY OF NEW YORK AND ANY AMENDMENTS THERETO, AND ANY APPLICABLE RULES Ah > NAME OF THE LICENSED PLUMBER (Print) _ SIGNATURE OF THE LICENSED PLUMBER f « ADDRESS OF THE LICENSED PLUMBER SREETE LICENSE NUMBER Pil \ a treatment Plant. : This private treatment plant discharges L 7 does not discharge / / to the City sewer system. “2. Number of premises indicated Total number of connections indicated : —_—— TO THE PLUMBER: ALL HOUSE CONNECTION DRAINS TO BE GRAVITY LINES ONLY. oe , . . . . / f ? = fen Pyet i. (ETF eee 7 iv 1 No Conese & [SE EEN © N44. Conver Te J CEnTet fv AVATOES AND OPERA OR ARE EBY NOTIFIED OF THEIR OBLIGATION The TH CITY OF NEW YORK - DEPT. OF ENVIR. PROT. BUREAU OF SEWERS : PERMIT CONTROL SECTION ° leer L van OMPLY WITH THE PROVISIONS OF APPROV ED | OAL CODE-RULE NO; 53 BEF BY DATE { a EXCAVATION OR DEMOLITION | eet T i ue ERATION IS CO cep APPROVAL VALID FOR THIRTY (30) i} FILL IN PERMIT NUMBERS ABOVE. TOTAL FEE PAID $_ —_— DATE: CLERK . “ : BUREAU or WATER REGISTER WO PERMIT(S) oF ANY TYPE WILL BE ISSUED FROM THE BUREAU OF WATER REGISTER UNTIL ALL OPEN CHARGES RAVE BEEN PAID AND ALL KNOWN VIOLATIONS AGAINST THE PREMISES HAVE BEEN REMOVED TO THE SATISFACTION OF THE DEPARTMENT - NYC-WTC_000165061 BUREAU OF WATER POLLUTION CONTROL ¥/2 v3 Comments and. Approval Stamp PERMIT FEE $ DATE: 7 1. The sewer (5},50 which the pouse connection(s) is/are made, is/are / 7 is/are not f 7 connected to 8 privat ra ad _ —_oOo .