Commercial Sewer Permit

Commercial Sewer Permit
Tank # _____
BROOKS COMMUNITY SERVICE DISTRICT
COMMERCIAL SEWER PERMIT No._____
Name
Street Address
Mailing Address (if different)
__________________________________________________________________________
Telephone
Nature of business: ______________________________________________________
Approximate square footage of facility ______________
Number of owners or employees who will work there: Full time______ Part time______
New tank? _____Yes _____No
(if yes, applicant is responsible for costs of installation to district specifications. Specifications
will be attached to the permit.)
Desired date to start construction: ______________
Applicants Statement:
I hear by make application to the Brooks Community Service District for sanitary sewer
service for a commercial facility. I understand that this permit allows me to discharge only
sanitary sewage into the system. I understand that I am not to discharge any industrial
wastes, wash waters, or other wastes prohibited by the Brooks Community Service District
Use and Regulation Ordinance.
I hear by warrant that the above information is true to the best of my knowledge and belief. I
agree that I will bear all costs associated with installation of any new tank and service lines
and will pay the monthly service charge from date of permit approval. I understand that the
tank and service lines shall be installed to service district standards according to the
approved site plan (provided a site plan for approval). I understand this permit does not grant
permission to construct anything in the public right-of-way. A separate Marion County permit
is required to perform work in a public right-of-way.
I understand that the Brooks Community Service District will accept these improvements to
the District and maintain them as a part of the District not less than one year after the
completion of the improvements to the satisfaction of the District Engineer. I understand that I
will be responsible for all corrective maintenance work needed on the improvements during
the referenced period.
The Applicant shall indemnify and save harmless the Brooks Community Service District, its
governing body, its officers and employees from all suits and actions: or claims of any
character brought because of any injury or damages received or sustained by any person, or
property on account of the operations of the said Applicant, his Subcontractors or the
employees of either; or on account of or in consequences of any neglect in safeguarding the
work; or because of any act or omission, neglect or misconduct of the said Applicant.
The Applicant accepts and approves the terms and provisions contained and attached
hereto, including the special provisions. Permits for construction expire one (1) year from
date of issue.
APPLICANT SIGNATURE: _____________________________Date___________________
FOR DISTRICT USE ONLY
**********PERMIT REQUIREMENTS**********
INSURANCE CERTIFICATION ON FILE [ ]
SUBMITTED HEREWITH [ ]
ATTACHED STANDARD DRAWINGS: STEP tank, Line Tap__________________________
SPECIAL PROVISIONS:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
GENERAL PROVISIONS:
1.
CALL DISTRICT INSPECTOR AT 503-588-5304, 24 HOURS PRIOR TO START OF
WORK AND 24 HOURS PRIOR TO COVERING WORK.
2.
A copy of an approved permit must be on the job at all times that work is being
performed.
3.
All mechanical equipment shall be manufactured by Orenco Systems Inc., as specified
on the attached sheets. (Orenco Systems Inc., 814 Airway Avenue, Sutherlin, OR
97479, telephone number 541-459-4449)
Size of Tank required:
Size of Pump required:
Approved:
__________________
__________________
____________________ Date________________
Title: __________________________ Expiration Date_______________
G:\Administration\ServiceDistricts\Brooks\FormsAndSpecs\PermitApplicationForms\PermitApplication_commercial.doc
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