Lake Herman Sanitary District

The following is the suggested form and content, but not limited to the same, for a Class A Sewer Application and Permit:

The undersigned, being the ________ (owner) ____________ (owner's agent) or the property located at _________________does hereby request a permit to install a wastewater treatment system and facilities to serve a ________ (residential building) ___________ (commercial building) at said location and do hereby furnish the following information in reference to the same:

1. The proposed system and facilities will include the following: ____________________________________________, and to be constructed in complete accordance with the plans and specifications hereunto attached as Exhibit “A”.
2. The area of the property lot to be served and on which the building is located is _____ square feet.
3. The name and address of the person or firm who will perform the work is ____________.
4. The maximum number of persons to be ordinarily served by the proposed system and facility is _______.
5. The locations and nature of all sources of private or public water supply within one hundred fifty (150) feet of any boundary line of said property are as shown on the plat hereunto attached as Exhibit “B”.

In consideration of the granting of this Permit, the undersigned does hereby further agree as follows:

1. To furnish any additional information relating to the proposed work that shall be requested by the District.
2. To accept and abide by all applicable provisions of the Ordinance on SEWER AND WASTEWATER TREATMENT of Lake Herman Sanitary District of Lake County, South Dakota, and all other pertinent and applicable rules, regulations, and specifications.
3. To operate and maintain the wastewater treatment facilities covered by this application in a sanitary manner at all times and at no expense to the District.\
4. To notify the District not less than twenty-four (24) hours prior to commencement of the work proposed; and, again to notify the Superintendent when the system is ready for final inspection before connection with any building sewer and before any portion of the work is covered.

Dated this ______ day of __________________, 20_____.

____________________________________
(owner)                      (owner's agent)             

Address of applicant is:                                  

_____________________________________
_____________________________________

 
Fee of $_____ paid _____________________.

Application approved and permit hereby granted on this _____ day of __________________, 20____.

______________________________
LAKE HERMAN SANITARY DISTRICT