Engineering & Inspections
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
Application Review: Staff will review application for completeness within 24 hours of submission. Applicants will
be notified to pick up incomplete applications and re-submit once the application packet is complete.
Applicant Name: __________________________________________ Date: _____________________
Applicant Address: _____________________ City: ______________ State: _______ Zip: __________
Subdivision/Development: __________________________________ Lot#: ______________________
Property Owner: ______________________ Phone #: ____________ Email: _____________________
Address: ____________________________ City: _______________ State: _______ Zip: ___________
Project Contact: _______________________ Phone #: ____________ Email: _____________________
Address: _____________________________City: _______________ State: _______ Zip: ___________
Project Address: ______________________________________________________________________
Description of Proposed Work: __________________________________________________________
Floodplain Onsite: Yes ____ No ____ Stream/wetland Onsite: Yes ____ No _____
*If checked “yes” please provide Flood Plain Development Permit
Type of Permit: Commercial Plumbing ____ Residential Plumbing ____
Total Project Cost: $ ____________________
Size of Water service and meter: ¾”____ 1”____ 1-1/2”____ 2”____ other? _____
Water Source: Town Of Clayton Utility _____ Johnston County Water Utility ______ Other: _______
*If septic system is present, a copy of the permit MUST be provided from Johnston County Environmental Health.
Permit#: _______________________
Received: ______________________
Complete all additional information for Plumbing Irrigation Permit noted.
Irrigation Plumbing Permit: Total Cost of Plumbing Project $_______________
Plumbing Contractor Name: _______________________________________ Phone #: _________________
Address: ____________________________________________ City: ___________________________
State: ___________ Zip Code: ____________ Email: _______________________________________
NC PLUMBING License #: ___________________ Classification: ____________________________
Irrigation Contractor (if applicable): ______________________________ Phone #: ________________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ______________ Email: _______________________________
Irrigation License #: ___________________
The following documents are required prior to permit issuance:
[ ] Cost of plumbing project provided
[ ] All plan reviewers have signed off on approvals
[ ] Fee paid at pick-up
I/We hereby certify that all information in this application is correct and all work will comply with the
State Plumbing Code and all other applicable State and local laws and ordinances and regulations. The
Inspection Department shall be notified of any changes in the approved plans and specifications for the
project permitted herein.
II/We further certify that I/We have full legal right to request such action and that the statements or
information made in any paper or plans submitted herewith are true and correct to the best of my
knowledge. I/We understand this application, related material and all attachments become official
records of the Town of Clayton, North Carolina, and will not be returned.
_______________________________________ _______________________________
Applicant’s Signature Date
_______________________________________ _______________________________
Owner’s Signature Date
Staff Approval:
_______________________________________ _______________________________
Inspector’s Approval Date
______________________________________ _______________________________
CO Final Date
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