www.greenbaywi.gov
SEWER CONNECTION
SPECIAL ASSESSMENT
ELECTION
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
I, _____________________________________________, have applied for a storm sewer
connection for my property at _________________________________________.
I understand that the connection assessment fee is:
Mini-storm Sewer Connection Assessment Fee $500.00
6" Storm Sewer Connection Assessment Fee $970.00
12" Storm Sewer Connection Assessment Fee $1,720.00
I am electing to not immediately pay this fee in full. I understand that this fee will be assessed
to the property at ________________________________________________________
and show up as a special charge on my tax bill, payable over five (5) years with
interest. The 2020 interest rate for unpaid special assessments is 3.77% per year.
I also understand that there is a $30 plumbing permit fee that must be paid at the time the
permit is applied for.
Date:
Signature:
Print Name:
Address:
This section for City Use only
Project #: __________
Permit Code: __________
Permit Fee: __________
Receipt #: __________
Date Paid: __________
Parcel #:
(Rev 02/20)
i:\deptdata\planning\inspectiondivision\forms\fillable\specialassessmentelectionsewerconnection
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