Fillable PERMIT APPLICATION WATER CONNECTION (EXTERNAL) STORM, SANITARY AND (City of Green Bay)

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PERMIT APPLICATION WATER CONNECTION (EXTERNAL) STORM, SANITARY AND (City of Green Bay)

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The PERMIT APPLICATION WATER CONNECTION (EXTERNAL) STORM, SANITARY AND (City of Green Bay) form is 1 page long and contains:

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  • 11 check-boxes
  • 24 other fields

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File type: PDF

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www.greenbay.wi.gov
STORM, SANITARY AND
WATER CONNECTION
PERMIT APPLICATION
(EXTERNAL)
Department of Community
and Economic Development
100 N. Jefferson Street, Rm 608
Green Bay, WI 54301-5026
(920) 448-3300 - phone
(920) 448-3426 - fax
inspmail@greenbaywi.gov
All fields must be completed before permit will be processed.
Project Address:
Owner's Name:
Owner's Email: Phone #:
Plumbing/Utility Contractor:
Contractor’s Address:
Contractor's Email:
Contractor's Phone #: Value of Work:
Bonded/Insured with City of Green Bay:
Yes
No
(For right-of-way impact)
I hereby make application for a permit for the following described sewer/plumbing work at the above location.
External Plumbing/Sewer
Water Service Connection
Sanitary Sewer Connection
Storm Sewer Connection
Description of Work:
To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one business
day in advance. Final inspections are required for all projects.
Contractor's Signature:
Credential #
Check box for Online Payment
The information below must be provided for notification of project number and permit fee. This information is required to make
payment online.
Phone
Fax
Email
Excerpt from City of Green Bay Plumbing Code:
Section 16.06 Permit must be procured before starting work: If any work regulated by the Plumbing Ordinance for which a permit is required
is commenced without a permit first having been obtained thereof, double the permit fee herein prescribed shall be paid when a permit finally
is obtained. Payment of any fee mentioned in this Section, however, shall in no way relieve any person of the penalties that may be imposed for
violation of the Plumbing Ordinance.
(Rev 6/2020)
This section for City use only
Sewer Request Filed:
Sewer Verified:
Project #:
Permit Code:
Permit Fee:
Assessment Fee:
Parcel #:
Receipt #:
Date:
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PERMIT APPLICATION WATER CONNECTION (EXTERNAL) STORM, SANITARY AND (City of Green Bay)

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Completed 3 August 2020

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