CITY OF ROSSFORD, OHIO
SEWER PERMIT

Page 1 of 4
No.____________________
Zoning Permit:___________
__________________Sewer

Application for Building Sewer Installation

NOTICE - Backfilling in Streets, Driveways and Alleys must be thoroughly tamped in 6-inch layers.

Date____________________

Type of Occupancy__________________________________________________________________

Legal Description of Property:__________________________________________________________

Located on the _________________ Side of _________________________________________Street

Type of Building Sewer to be Installed___________________________________________________

Size of Building Sewer __________________Inch Size of Public Sewer ____________________Inch

Nature of Construction (CHECK ONE)    /___ /   New       /___ /  Repair

Estimated Cost of Work:______________________________________________________________

Metered Water __________Yes __________No        Charges: Inspection Fee___________________

Installed By:____________________________________     __________________________________

Inspected By:___________________________________    __________________________________

Date Installed ___________________________________   Total Charge________________________

Make Checks payable to: City of Rossford, Ohio

The undersigned hereby makes application for a permit for the construction, installation, replacemtn or repair as herein specified and agrees to do all such work in strict accordance with the City of Rossford, and Wood County Board of Health, and the undersigned further agrees that all claims for damages against the City which may be occasioned in any manner by the putting in of said building sewer, shall be waived and held null and void; and the undersigned shall indemnify and save harmless the City of Rossford from any and all claims whatsoever occasioned by the construction of said improvement.

Signature of Applicant:_______________________________________________________________

                    Address:_______________________________________________________________

NOTE: This receipt not valid until receipted by City Sewer Department. Permit shall be left on job site.

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Sewer Permit No.

Building Sewer Installation Information

(NOTE: The work shall be completed and this form filled out and returned to the Rossford Sewer Department Office within thirty (30) days after permit is issued. The owner is to have the right to make new application if work is not completed within the specified time.)

For Lot. No. _____________________ located on _________________________side of

________________________________ in ______________________________________________
              Street Name                                                    City, Township, Etc.

lot owned by______________________________________________________________________

Connection enters lot______________________________ feet from _________________________
line of said property.

Installed _______________________(total length) feet, of __________________inch, Building Sewer, as shown in sketch on back side of this form.

I hereby certify, that the above connection was properly made by me on the day of ____________________, 19 _____, in conformity with the rules and regulations of the City of Rossford, governing the construction of sewer connections with all of which I am familiar; that the connection was made in a proper manner without damaging the main or principal sewer; that said connection was laid to a true and proper grade, and constructed of
____________________________________________________________
sewer pipe, with premium joints properly jointed and tight, and connected at the upper end with cast iron soil pipe; and that the whole was left clean and in good condition.

ROSSFORD, OHIO

Date_____________________________________

________________________________________ (Building Sewer Contractor)

           This work inspected and approved this____________________ day of

______________________________, 19 ____.

______________________________________
(INSPECTOR)                         

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SUMMARY OF REGULATIONS FOR THE MAKING OF BUILDING SEWER CONNECTIONS WITH PUBLIC SEWERS.

1. A written permit must be obtained from the Sewer Department of the City of Rossford to make any extension, connection, repair or opening into the public sewer in Rossford, Ohio, or in any area under the jurisdiction of said City.
   
2. Such permit may be secured by a licensed building sewer contractor or written authorization of the owner or agent.
   
3. No work shall be done on any connection before permit is taken out.
   
4. At least 48 hours notice with the exception of Sunday and holidays, shall be given to the City Inspector and the proper Authorities prior to opening any street or public way, for which a permit has been issued. Permits must also be secured to open any pavement or improved road.
   
5. All building sewer contractors' licenses expire on the 31st day of December each year.
   
6. All work on sewer connections shall be done in accordance with the Rules and Regulations of the City of Rossford.
   
7. Penalties are imposed on both the owner and building sewer contractor if the provisions governing making of sewer connections are not complied with.