To: Permit Applicants
From: Town Clerk
Re: Act 125
Due to the passage of Act 125, towns are now required to record a Memorandum of Municipal Action (24 V.S.A. section 4443 (c).
The Memorandum is a one-page document to be recorded in the Land Records and requires a seven ($7.00) dollar fee to be paid to the Town of Clarendon.
Please add the seven dollars ($7.00) to the permit fee. Checks should be made out to the Town of Clarendon.
If you are submitting more than one permit (septic, building & access) at the same time, the seven-dollar fee will cover all permits. If permits are submitted at different times, each permit will require the fee of seven dollars.
TOWN OF CLARENDON
PERMIT APPLICATION FOR SEPTIC SYSTEM
Required for construction of new or replacement system or ANY repair.
Required Fee $60.00
(Submit Application in duplicate with fee to Sewage Officer)
Date: ______________________ Application # _______________
Landowner: _______________________________ Phone: ___________________
Address: _________________________________ Phone: ___________________
_________________________________
Exact Location of Property: _______________________________________________________
Proposed Use: ________________________________________________________________
Gallons per day of sewage: (450 for single family home) ________________________________
New or Replacement: ___________________ Name of Contractor: ____________________
Describe proposed system in detail: Size septic tank, Number, size, depth of trenches, size and depth of bed, dry well capacity, etc.
On back of each copy, or on separate pages, submit detailed and dimensioned sketch showing locations of structure, septic tank, distribution box, disposal facility (trenches, bed, etc.), well, neighboring well and septic, property lines and any body of water or stream. Also show slope of ground with arrows and contours.
Indicate how system is sized: ____________________________________________________
Signature of Owner or Applicant as Owner’s Agent
THE INFORMATION GIVEN IS THIS APPLICATION IS CORRECT
_____________________________________________________
Based upon the representations in this application, construction may proceed.
Date: _______________________ __________________________________
Sewage Officer
Denial ( ) Reason: ___________________________________________________________
_____________________________________________________________________________
Inspection required prior to use or covering system. Contact Sewage Officer at least 24 hours prior to beginning construction.
INSPECTED BY : _______________________________ Date: ______________________
NOTE: Granting this permit does NOT relieve landowner from full responsibility for operation of the septic system.