2. 
4. Application Information:
6. Applicant Name: *
7. Ownership Status*

   Owner, Lessee, Tennant, etc.

9. Property Information:
11. Street #*
12. Street # Suffix
13. Street Name*
15. Company Name*
16. Total Square Footage of Building*
18. Nature of Business / Industry
20. Phone #*
21. Email Address*
23. Contractor Information:
25. Contractor Name*

    Contractor who will perform the proposed work

26. Contractor Address*
28. Contractor Phone #*
29. Date of Proposed Work *
    Date of Proposed Work
31. Terms

    By submitting this application you agree to the following terms:

    1. To furnish any additional information relating to the installation or use of the industrial sewer for which this permit is sought as may be requested by the City of Westfield, Board of Public Works. 2. To maintain the building sewer at no expense to the City. 
    3. To accept and abide by all provisions of City Ordinances Sec. 18-211 to 18-216 and all other pertinent ordinances or regulations that may be adopted in the future. 
    4. To operate and maintain any waste pretreatment facilities, as may be required as a condition of the acceptance into the public sewer of the industrial wastes involved, in an efficient manner at all times, and at no expense to the City. 
    5. To cooperate at all times with the Board of Public Works and their representatives in their inspecting, sampling, and study of the industrial wastes and any facilities provided for pretreatment. 
    6. To notify the Board of Public Works or its agent immediately in the event of any accident, negligence, or other occurrence that occasions discharge to the public sewer of any waste or process waters not covered by this permit. 
    7. To notify the Board of Public Works or its agent when the building sewer is ready for inspection and connection to the public sewer, but before any portion of the work is covered. 

    
    

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field