Industrial sewer connection applications and wastewater discharge permits shall be in substantially the following forms:
INDUSTRIAL SEWER CONNECTION APPLICATION
To the City of San Juan Bautista:
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 sewer connection for which this permit is sought as may be requested by the City.
2.
To accept and abide by all provisions of the Sewer Use Ordinance and Wastewater Discharge Regulations of the City of San Juan Bautista, 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 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 its 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 the contribution of any wastewater or substances prohibited or not covered by this permit.
Date: _______________     Signed _______________
$_____________ inspection fee paid ______________________________
Application approved and permit granted:
Date: _______________     Signed _______________
City of San Juan Bautista
Department of Public Works
WASTEWATER DISCHARGE PERMIT
Permit No. ___________
In accordance with all terms and conditions of the San Juan Bautista City Code, Part ___________, Article ___________, ______________________, Section ___________, et seq., and also with any applicable provisions of Federal or State law or regulation; Permission Is Hereby Granted To _________________________________
Classified by SIC No.
For the contribution of
For the contribution of
Into the City of San Juan Bautista sewer lines at
This permit is granted in accordance with the application filed on ______________________, 20___, in the office of the City Manager and in conformity with the plans, specifications, and other data submitted to the City Manager in support of the above application, all of which are filed with and considered as part of this permit, together with the following named conditions and requirements.
Effective this ______ day of ___________, 20___
To expire _____ day of ___________, 20__
________________________________________