Fillable SEWER CONNECTION APPLICATION (City of Veneta)

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SEWER CONNECTION APPLICATION (City of Veneta)

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File type: PDF

U.S.A. forms for City of Veneta

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S:\Building\BUILDING\FORMS & HANDOUTS\Sewer Connection Application
Residential Commercial
Applicants Name: Phone #:
Service Address: Permit#:
Mailing Address:
State Zip
Assessor's Map:
Contractor's Name: Phone #:
Contractor's CCB:
Approved: Tap & Cut into sewer as shown. Hook-up Charge:
Approved: Connect to stub as shown System Dev. Charge:
Approved: Re-connect to previous connection as shown Date Paid:
Denied: For reasons specified below Receipt #:
PO Box 458 * Veneta, OR 97487 * 541-935-2191 * 541-935-1838 * www.VenetaOregon.gov
FOR CITY HALL OFFICE USE
Fees
SEWER CONNECTION APPLICATION
Other
Street/PO Box
City
Date
City of Veneta Public Works Director
Subdivision or Tax Lot#:
I hereby apply to the City of Veneta for permission to install a sanitary sewer service connection for the property listed above. I agree to comply with all City of
Veneta regulations governing the installation and operation of sanitary sewer lines. I also agree that no work shall begin until approval has been granted by the
C
ity and as-built drawings of the installation have been submitted and approved.
Date
Expiration Date:
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SEWER CONNECTION APPLICATION (City of Veneta)

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Completed 17 July 2020

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