Fillable Sewer Water Forms031912 (Kittitas County WA)

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Sewer Water Forms031912 (Kittitas County WA)

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Certificate Number:
Application Date:
Status:
Single Family Dwelling Building Permit
Preliminary Plat
Commercial/Non-residential Building Permit
Short Subdivision
1. A. ( ) Sewer is currently provided by a side sewer connection to an existing________________inch
lateral into a _____________ size sewer main located ____________________________________.
B. ( ) Sewer service will be provided by a lateral side sewer connection to an existing ___________inch
size sewer main located ________________feet from the site.
C. ( ) Sewer service will require an improvement to the sewer system of:
1. ( ) ___________ feet of sewer main extension to reach the site; and/or
2. ( ) the construction of a collection system on the site; and/or
3. ( ) other (describe) ________________________________________________
2. A. ( ) The sewer system improvement is in conformance with a City approved sewer comprehensive plan.
B. ( ) The sewer system improvement will require a sewer comprehensive plan amendment.
3. A. ( ) The proposed project is within the corporate limits of the City, or has been granted Boundary
Review Board approval for extension of service outside the City.
B. ( ) Annexation or BRB approval will be necessary to provide service.
4. ( ) Service is subject to payments of all connection charges in effect at the time of permit issuance.
5. ( ) The sewer system is not capable of providing sewer service.
Conditions:
CONDITIONS
BLACK DIAMOND APPLICATION FOR SEWER AVAILABILITY INVESTIGATION
Describe Proposed Project:
Project Address:
Parcel #:
Phone:
Applicant Name:
Mailing Address:
City, St, Zip:
Applicant Signature:
Date:
SEWER INVESTIGATION APPLICATION
Building Square Footage:
Project Name:
OFFICIAL USE ONLY
PROVIDE A SITE PLAN WITH LOCATION OF STRUCTURE AND A VICINITY MAP.
THIS INVESTIGATION FORM WILL BE VALID FOR A PERIOD OF 12 MONTHS FROM THIS DATE. A
CERTIFICATE OF SEWER AVAILABILITY WILL BE ISSUED AT TIME OF BUILDING PERMIT ISSUANCE.
Utilities Supervisor Date
NOTE: ALL EXTENSIONS MUST BE ENGINEERED BY A CERTIFIED ENGINEER AND APPROVED BY THE CITY
OF BLACK DIAMOND. ALL EXTENSIONS MUST BE CONSTRUCTED TO CITY OF BLACK DIAMOND
ENGINEERING DESIGN AND CONSTRUCTION STANDARDS.
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Sewer Water Forms031912 (Kittitas County WA)

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Completed 18 January 2021

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