200 S. MAIN STREET / P.O. BOX 826
CONTRACTOR NAME: PHONE:
PROPERTY OWNER NAME: PHONE:
Pumps/Connections for Pumping Equipment:
Plans Attached: Valuation (cost of project):
Base Fee For Issuing each Permit $ 50.00
Irrigation System - Residental (1 & 2 family dwellings) $ 50.00 each
Irrigation System - Commercial $100.00 each
Backflow Prevention Device - 2 inches or less $ 20.00 each
Backflow Prevention Device - Over 2 inches $ 25.00 each
Special Notes: Plan Review:
Provide the customer with a copy of the permit.
No plan review fee for one & two family
Inspections required for all devices and systems.
No backflow prevention device shall be installed in the
Plan reivew fee applies to commercial projects
Initial and annual inspection reports are required on all
testable devices. Reviewed by: Date:
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN
OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY
CITY GUIDELINES, ORDINANCES, CODES, STATE OR LOCAL LAWS PERTAINING TO OR REGULATING CONSTRUCTION OR THE
PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF AUTHORIZED AGENT PRINTED NAME DATE
**NOTE: Inspection of permitted work may reveal code violations not discovered during plan review.
ANY TIME AFTER WORK IS COMMENCED.
WITHIN 6 MONTHS, OR IF CONSTRUCTON OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 6 MONTHS AT
THE IRRIGATION PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED
Is any part of this property located in a Floodplain:
Chemical Injection (or provision for):
Phone: (210) 658 - 4175 Fax: (210) 658 - 8065
BUILDING PERMIT APPLICATION - IRRIGATION
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