APPENDIX E: WATER LINE CONSTRUCTION PERMIT FORM

 

Permit # ______    TOWN OF BREMEN    WATER LINE CONSTRUCTION    PERMIT   Date ______________________   Name of Applicant: ______________________________ Address: _______________________________________ __________________________________________ Phone Number __________________________________   Address where construction is to take place (if different than above). ______________________________________________________________   Purpose of Construction, Check One – Replacement Water Line ________ New Water Line ________ Relocate Water Line ________   Other (describe) _______________________________________   What size water line is being constructed or replaced? ________   What type of water line material will be used? check one –   Copper ________ Plastic ________ Ductile Iron ________     When is Construction Scheduled to Take Place?   Date _________________________   Diagram Project, show Streets, lot, Building on Lot and where construction will take place. Use the area below or the backside of this form.           Date Reviewed __________________ Approved ________         Denied ________   Reason Denied __________________ ______________________________________________________________ By __________________________   For Inspection call 546-4324

 

(Prior Code, Ch. 104)