Y:\City Hall\Community Development\FORMS\PERMIT APPS & HANDOUTS\NSF HOME - Building Permit Package\2020 Building Requirement Revision\Sewer
Permit Application.doc Revised 12.13.19
Master Building Permit No.:
Sewer: Deferred or Non-Deferred (circle one)
Application is hereby made to the CITY OF SPRING HILL, KANSAS by the undersigned
owner or agent for a SANITARY SEWER CONNECTION PERMIT.
Applicant agrees to install or have installed, by a licensed plumber, the sanitary sewer
connection. The applicant agrees to conform at all times to all plans and specifications
prepared by and/or approved by the City Inspector of the City of Spring Hill, Kansas and to
comply with the City ordinance governing sanitary sewer connections. When the work is
ready for final inspection, the City Inspector, or his duly authorized agent, will immediately
be notified. The owner or agent agrees to pay a fee of $ at the time this
application is granted which will include one inspection for final approval.
Name of Owner Address Phone No.
Name of Contractor Address Phone No.
Legal Description:
Property Address:
Subdivision Phase/Plat:
Lot No. Block No. Type of Construction: Commercial Residential
Signature:
Applicant/Owner/Agent Date
Printed Name:
Applicant/Owner/Agent
Sanitary Sewer Permit Application
Community Development/Planning Dept.
401 N. Madison St., Spring Hill, KS 66083
(913) 592-3657 ● (913) 592-5040 FAX
planning@springhillks.gov ● www.springhillks.gov
OFFICE USE ONLY
The above applicant is hereby granted permission to proceed with construction of said sanitary sewer and connection
as stated in said application subject to approval by the City Inspector or his duly authorized agent.
Authorized by: Date:
Backwater valve: Basement only Whole house First and Second floor
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