Town of Saratoga

4/8/2018 TOWN OF SARATOGA APPLICATION FOR SEWER/SEPTIC PERMIT

Date______Permit No.______SBL#______

APPLICATION IS HEREBY MADE to the Department of Building and Development for the issuance of a permit pursuant to the New York State Fire Prevention and Building Code, for the installation of a septic system/sewer connection, or for alterations or additions, or the removal or demolition of same, as herein described. The Applicant agrees to comply with all applicable laws, ordinances, or regulations governing building activities in the Town of Saratoga and will also allow all inspectors to enter the premises for inspections.

Applicants Name______Owner’s Name______Address______Address______Zip______Zip______Phone# ______Or______Phone ______Or______

Address of Construction______Water Source______

( ) Sewer-Name or Approved Subdivision______OR the sewer company permission letter MUST be provided.

( ) Septic System-______

______Signature of Owner, Applicant or Agent

______

Total Fee Due: ______Check # Amount Collected Date Initials

The application of ______dated______is hereby approved (disapproved) and permission granted (refused) for the installation, construction, or alteration of a septic or sewer system as set forth above.

Reason for refusal of permit: ______

Dated______4/8/2018 Authorized Signature