TOWN OF BRADFORD

RESIDENTIAL OR COMMERCIAL BUILDING SEWER APPLICATION

Please print this form - complete the following information and mail to:

Bradford Water & Sewer Commission

PO Box 603 - Bradford, VT  05033

The undersigned, being the _______________________________  ______________________

                                                                                (owner, owner’s agent)                                      (applicant)

the property located at:  _____________________________________, does

                                                                (Number)     (Street)

 hereby request a permit to install and connect a building sewer

to serve the _______________________________________ at said location.

                                (Residence, Commercial Building etc.)

1.         The maximum number of persons who will use the above building is ________.

2.         The maximum number of gallons requested per day is __________.

3.         Character of pollutants to be discharged are:  _________________________

            ______________________________________________________________

4.         The name and address of person or firm who will perform the proposed

work is:  __________________________________________________

5.         Plans and specifications for the proposed building sewer are attached hereinto as exhibit “A”.

In consideration of the granting of this permit, the undersigned agrees:

1.         To accept and abide by all provisions of the Sewer Ordinance of the Town of Bradford as adopted on June 14, 1978, amended on May 24, 2007, and of all other pertinent ordinances or regulations that may be adopted in the future.

2.         To maintain the building sewer at no expense to the Town.

3.         To notify the Board of Water & Sewer Commissioners or their authorized agent when the building sewer is ready for inspection and connection to the public sewer and before any portion of the work is covered.

Date:  _____________________  Signed:  ________________________________

                                                                                                                (Applicant)

             _____________________________________________________________

                                (Address of Applicant)

$__________ Inspection and Connection fees paid.  ________________________

                                                                                                                                (Received by)

Application approved and permit issued:

Date:  _____________________  Signed:  _________________________________

                                                                            Town of Bradford Water & Sewer Commission

Permit is valid for 2 years from the date of approval.