Application for a SANITARY SEWER permit

Full name *

Full address *

I am requesting from the Village de Memramcook a permit to hook up to the public sanitary sewer line at the aforementioned address which I am the property owner. *

Yes

Plumbing permit number *

Installation of a backflow prevention device *

Yes

I agree to comply with and observe at all times the by-laws and regulations of the said municipality pertaining to the water system. Also, I give permission to the officials, employees and agents of the Village de Memramcook at any time when the said officials, employees or agents may consider it necessary to do so, to enter the said premises in order to ascertain that the by-laws of the municipality regulating the water system are being observed, with an appointment and under the owner’s supervision or his/her representative. *

Yes

The sanitary sewer pipe installation from the property line to the building will be performed by:

Name of the plumber / person performing the installation *

Address of plumber / person *

Address Name of the person / contractor performing the work *

Address of person / contractor *

Name