OFFICE USE ONLY

BOARD APPROVAL

[  ] Sizing Required      [  ] NO Sizing Required     [  ] New Waste Data Disclosure Form Needed

Contingencies: ______________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Board Member: _______________________________________________________

Board Member: _______________________________________________________

Board Member: _______________________________________________________

Date Board Approved: ____________________________

PROJECTED CAPACITIES NEEDED: 

Previous ER's paid ________. 
Additional projected number of ER's needed ________ @ $8,894 each. 
Total $ ________.

Signed: _______________________________________________________

Date: ____________________________

Please complete the following.

I, , dba , request permission to increase and/or change my use for the service connection installed into the District system, for the property located at:

Town or Area:  BLK# LOT#

Other Location Description:  

Type of Business to be using sewer:  Check if Lease Space: 

Number of Employees: Square Footage of Building:

Hours of Operation: Number of Days per Week:  

Number of Toilets: Number of Sinks:

Number of Tubs: Number of Washing Machines:

Number of Floor Drains:  

Restaurant, Bar or other business with public seating: Number of seats available:  

Other uses of water, etc., which will be drained into the sewer system: 

Changes in my sewer discharge are as follows:

Business Name(s):  Building Owner: 

Billing Address:

Phone:

I understand:

1. The plans for this project must be reviewed by the District Staff, Board of Directors, and possibly an Engineer.
2. Additional New User Facility Fees (NUFFs) may be due with this application if the projected number of capacities/ERs (equivalent residences) needed exceeds the number of ERs previously paid.
3. If at any time, one year’s average metered use exceeds the total number of ERs/capacities paid, additional NUFFs will be due at the then-current rate, if there is capacity available.
4. If I should expand or change my usage after this application is processed, I shall submit a new Usage Update Application to the District office prior to increasing or changing usage.
5. The District does not guarantee the availability of future capacity and reserves the right to deny additional capacity/ER requests at the discretion of the Board based on the District’s system resources.

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Signature Certificate

Document name: Commercial-Industrial Usage Update

Unique Document ID: 381cbf5b8a303435f050d69ec73c5c14486a4589

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Timestamp	Audit
March 18, 2020 4:19 pm PDT	Commercial-Industrial Usage Update Uploaded by Colleen Johnson - [email protected] IP 156.146.51.79
March 19, 2020 8:32 am PDT	Laura Dallas - [email protected] added by Colleen Johnson - [email protected] as a CC'd Recipient Ip: 38.146.75.102
October 5, 2022 12:32 pm PDT	Laura Dallas - [email protected] added by Colleen Johnson - [email protected] as a CC'd Recipient Ip: 156.146.51.79
October 5, 2022 12:34 pm PDT	Laura Dallas - [email protected] added by Colleen Johnson - [email protected] as a CC'd Recipient Ip: 156.146.51.79

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://kootenaiponderaysewerdistrict.org/

Audit Trail Serial# f1e9bfcccb44c3add8ba86ee57d5b2b2