DeKalb County Department of Planning
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Andrew
A. Baker, AICP
Michael Thurman
Chief Executive Officer
Director
SEWER CONNECTION
PERMIT
APPLIC
A
TION
AP PROVAL AND ISSUANCE OF THIS PERMIT AUTHORIZES ONLY THE APPLICANT’S RIGHT TO
CONNECT TO THE DEKALB COUNTY SEWER SYSTEM AT THEIR OWN EXPENSE. A PLUMBING PERMIT
SHALL BE REQUIRED BY A LICENSED SEWER/PLUMBING CONTRACTOR PRIOR TO INSTALLATION OF
THE PRIVATE SEWER LINE CONNECTION. THERE IS NO GUARANTEE OF A STUB ON THE LINE.
CUSTOMER
SECTION
Application Date: _______________________ Sewer Connection Number: ______________
Address of Sewer Connection: _______________________________________________________________
Property Owner’s Name: ___________________________________________________________________
Property Owner’s Address: _________________________________________________________________
City: _______________________ State: _______________ Zip Code: ________________
Map Reference Number: DIST:______ LL: _______ BLK: _______ PARCEL:________________
Sewer/Plumbing Contractor: ________________________________________________________________
Street Address: __________________________________________________________________________
City: _______________________ State: _______________ Zip Code: ________________
Applicant’s Signature: _____________________________________________________________________
DEPARTMENT USE
ONLY
_______ New Building _______Conversion _______Additional Charge
____Assembly ____Medical Care ____Manufacturing
____Retail ____Retire/Nurse Home ____Warehouse
____Food/Beverage ____Personal Service ____SF Attached
____Laundry/Dry Clean ____Comm. Recreation ____SF Detached
____Auto Care/Repair ____Other___________ ____Multi-Family
No. of Units _____
If Personal Service/Beauty Salon/Barber Shop: No. of Shampoo Bowls _____ No. of Stations _____
Is Connection Available: (please check one) Yes _____ No _____
Floor Area: _____ GPD: _____ Seating Capacity: _____
____ NE Creek ____ Ball Mill Creek ____ Other
Sewer Connection Fee: __________________
330
West Ponce
de
Leon Avenue
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2nd Floor
-
Decatur, Georgia
-
30030
Phone:
404-371-2155 Fax: 404-371-2778
Web Address: https://www.dekalbcountyga.gov/
Rev.
06/26/19
click to sign
signature
click to edit
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