To the City of Lebanon:
| |
The undersigned being the ____________________ of the ____________________
property located at ____________________ does hereby request a permit
to __________ an industrial sewer connection serving ____________________,
which company is engaged in: ____________________ at said location.
| |
1.
|
A plan to the property showing accurately all sewers and drains
now existing is attached hereunto as Exhibit "A."
|
2.
|
Plans and specifications covering any work proposed to be performed
under this permit is attached hereunto as Exhibit "B."
|
3.
|
A complete schedule of all process waters and industrial wastes
produced or expected to be produced at said property, including a
description of the character of each waste, the daily volume and maximum
rates of discharge, representative analyses and compliance with any
applicable pretreatment standard or requirements, is attached hereunto
as Exhibit "C."
|
4.
|
The name and address of the person or firm who will perform
the work covered by this permit is: ____________________
|
| |
| |
In consideration of the granting of this permit the undersigned
agrees:
| |
1.
|
To furnish any additional information relating to the installation
or use of the industrial sewer for which this permit is sought as
may be requested by the City.
|
2.
|
To accept and abide by all provisions of Ordinance No. 22 of
the City of Lebanon, and of all other pertinent Ordinances or regulations
that may be adopted in the future.
|
3.
|
To operate and maintain any waste pretreatment facilities, as
may be required as a condition of the acceptance into the wastewater
treatment system of the industrial wastes involved, in an efficient
manner at all times, and at no expense to the City.
|
4.
|
To cooperate at all times with the City and his representatives
in their inspecting, sampling, and study of the industrial wastes,
and any facilities provided for pretreatment.
|
5.
|
To notify the City immediately in the event of any accident,
or other occurrence that occasions contributor to the wastewater treatment
system of any wastewater or substances prohibited or not covered by
this permit.
|
Date:
| |
Signed:
| |
$__________ inspection fee paid ____________________
| |
Application approved and permit granted:
| |
________________________________________ Supt.
|