HomeMy WebLinkAboutSanitary Service Application.pdfCORPORATION OF THE DISTRICT OF MAPLE RIDGE
City of Maple Ridge Engineering Department Address: 11995 Haney Place, Maple Ridge BC V2X 6A9 Phone: 604-467-7339 Fax: 604-467-7461 email: engineering@mapleridge.ca APPLICATION FOR SANITARY
SEWER SERVICE ESTIMATE CIVIC ADDRESS OF PROPERTY LEGAL ADDRESS OF PROPERTY (LOT AND PLAN NUMBERS) APPLICANT (PROPERTY OWNER) ADDRESS DATE OF APPLICATION POSTAL CODE PHONE EMAIL/FAX
PLEASE FILL IN OR CHECK APPROPRIATE BOXES PIPE SIZE (mm) NEW BLDG EXISTING BLDG SINGLE FAMILY MULTI FAMILY COMMERCIAL LOCATION STAKED ESTIMATES OFFICE USE ONLY SANITARY SEWER CONNECTION
$ PERMANENT DISCONNECT TEMPORARY DISCONNECT $ INSPECTION CHAMBER INSTALLED $ OTHER SUB-TOTAL $ GST $ TOTAL ESTIMATE $ TERMS AND CONDITIONS: I agree that I will comply with all City
of Maple Ridge by-laws, including the following: streets and traffic, sediment control, water, Maple Ridge sanitary sewer regulations by-law, Maple Ridge storm drainage system extension
regulations by-law and Greater Vancouver Sewerage and Drainage District sewer use by-law and amendments thereto in so far as they apply to my requirements and use. I also agree to save
the City, its elected and appointed officials, employees and agents harmless from and against all liability, actions, causes of action, claims damages, expenses, costs, debts, demands
or losses suffered or incurred by them or any of them, including consequential damages and damages to third parties whether known or unknown, foreseeable or not, arising from the installation
and use of the service connection. The municipality reserves the right to charge the applicant for any additional costs incurred due to problems encountered, which at the time of the
estimate were not known by the City. Payment of the connection fee must be made two (2) weeks prior to installation. Please make cheques payable to the City of Maple Ridge. **A stake
must be placed and marked with paint where the service is required. Note: This application for service estimate is valid for sixty (60) days only from date of estimate. OWNERS SIGNATURE:
___________________________________________________ DATE: ______________________________________