NO.___________                                                                            Class of Work                                                    

Building                                                                       New____________           Demolish__________
Address______________________________                     
                                                                                   Alteration________            Repair____________

Locality______________________________           
                                                                                   Addition_________           Move_____________

Nearest
Cross St._____________________________           Size of Bldg___________  Height____________

Permittee  Name_______________________           Use of Bldg._____________________________

Mailing Address_______________________           

City__________________Tel:_____________         No of Rooms_______        No. of Families______
Engineer Name_________________________         No. of Floors________       Size of Lot_________

Address_______________________________

City__________________________________        No of Bldgs.               Use of Bldg.
State License No.______________Tel:______         Now on Lot________   Now on Lot__________

                                                                                  Estimated Cost _________________________

Contractor Name_______________________         Cost of Permit  _________________________

Address_______________________________

City_______________________Tel:________        I hereby acknowledge that I have read this application and
                                                                                                             State that the above is correct and agree to comply with all
                                                                                                             City Ordinances and State Laws regulating Building Con-
                                                                                                             struction.

I, we, or either of us, the undersigned, hereby make application for authority to connect the premises described as follows to the municipal water and sewage works improvements, and hereby pay unto the City of Princeton, Iowa, the Water and Sewer Connection Charges for the following described property, the description being:
 ______________________________________________________________________________
 ______________________________________________________________________________

                     

1. A - Type of Building ________________________                                                   Residential                                                   Commercial                                                    Industrial      B - Number of Units ________________________ 2. Sewer Connection Charge paid herewith $400.00 3. Water Connection Charge paid herewith $150.00 4. The Name and Address of the person or firm who will make      house connection from lateral:                                             ________________________________________________ ________________________________________________

In consideration of the granting of a permit to install these facilities, the undersigned agrees to pay the rates of charges to be placed in effect by the City of Princeton.

Signed _____________________________ Signed _____________________________ Address ____________________________ Date _______________________________

APPROVED         ______ DISAPPROVED   ______  SIGNED  _________________________                  Mayor, City of Princeton, Iowa  SIGNED  _________________________                  City Clerk/Treasurer, City of Princeton, Iowa

 Citizen Complaint/Request Form

Date:______________

(Print)
Name:  ____________________________________            Phone: ____________

Address: ___________________________________________________      

Nature of Complaint:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Person Receiving Complaint:  ______________________________
Referred To: ____________________________   Date: _____________________

Action Taken:
______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
 

Follow-up Contact to Complainant:  Date: ______________________

How: _________________________    Who: _________________________