2. 
4. Property and Owner Information:
6. Owner Name, as it appears on deed *
8. Street #*
9. Street # Suffix
10. Street Name*
12. Number of Units*
13. Number of Bedrooms*

    Number of bedrooms that will use sewer connection

14. Gallons Per Day

    Estimate gallons per day for this connection

16. Phone #*
17. Email Address*
19. Contractor Information:
21. Contractor Name*

    Contractor who will perform the proposed work

22. Contractor Address*
24. Contractor Phone #*
26. Terms

    By submitting this application you agree with the following terms:

    1. To accept and abide by all provisions of City Ordinances Sec. 18-211 to 18-216 of the City of Westfield and all other pertinent ordinances or regulations that may be adopted in the future.
    2. To maintain the building sewer at no expense to the City.
    3. To notify the Department 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 at 572-6226.
    4. Septic tank MUST be pumped out - not discharged to City Sewer.
    5. Septic tank must be filled with sand or must be crushed.
    6. Clean out to be installed at property line, with ties to the permanent structure. 

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field