VILLAGE OF LOGAN
APPLICATION FOR NEW SEWER SERVICE AGREEMENT
SKETCH OF PROPOSED LOCATION FOR SERVICE FACILITIES

INSTRUCTIONS

Provide a sketch of the property to be served including the building, fencing, other site features, and existing utilities, such as septic tank, disposal field, gravity sewer line, water meter, water service line from meter to building, wells, gas meter, electric meter, telephone/cable TV service connections, and any buried utilities.  Provide a sketch of the desired location of the Grinder Pump Unit, Pressure Service Line, and Control Panel.  Contact the Village of Logan at (575) 487-2239, for an onsite review of the sketch and obtain concurrence prior to sewer construction.  Village personnel are available to provide assistance in the preparation of this sketch. 

SKETCH

APPLICANT'S STATEMENT

I concur with the general location of the sewer service facilities shown on this sketch.  If the Village and/or any of its subcontractors install any of the service facilities on this property, I understand the Village will attempt to minimize the disturbance and restore existing landscaping as much as possible but are ultimately not responsible for repairing or replacing landscaping, surface material or other surface, fencing, or buried and/or other site improvements that may be damaged during the installation of the service.

PROPERTY OWNER'S NAME (PRINT)

LAST NAME:                                                                     FIRST NAME:                                          MI:

PROPERTY ADDRESS TO BE SERVED

APPLICANTS SIGNATURE                                                                                       DATE

VILLAGE CONCURRENCE

The sewer service facilities shall be installed as generally indicated in this sketch if possible.

NAME (PRINT)                                                

SIGNATURE                                                

DATE                                               

DATE OF INSTALL                                                

START UP DATE                                        

LINE SPOT REF. #                                         

ELECTRICIAN'S PERMIT # (IF REQD)                                        

PLUMBER'S PERMIT # (IF REQD)                                                                                   

FINAL INSPECTION