Fillable Water Service - Permit Application (City of Winooski)

Fill Online, Printable, Fillable, Blank Water Service - Permit Application (City of Winooski) Form

Use Fill to complete blank online CITY OF WINOOSKI (VT) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Water Service - Permit Application (City of Winooski)

On average this form takes 12 minutes to complete

The Water Service - Permit Application (City of Winooski) form is 4 pages long and contains:

  • 1 signature
  • 43 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Winooski

BROWSE CITY OF WINOOSKI (VT) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
Water Service - Permit Application
New service connections
Repair or replacement of existing service connection
Hydrant usage
(Please Note – for any excavation work within the City Right-of-Way, a separate ROW permit is required.)
Fees (Chapter 28 – City of Winooski Ordinance, Last Updated 7/15/19
Water connection fee-residential
Single family home (3/4" or 1" tap): $1,000.00
Multi-family dwelling (each individual unit): $1,000.00
Water connection fee-commercial
Single commercial unit: $3,000.00
Multi-commercial (per unit): $3,000.00
Multi-commercial (one meter): $3,000.00
Hydrants
Fire hydrant user fee: $200.00
1. Property Information
Property Owner ___________________________________ Date __________________
Applicant Name (if different than property owner) ______________________________
Property Address ___________________________________ Phone _______________
Type of Property:
Single-Family Home
Multi-family dwelling: Number of units _______
Commercial: Number of Units _______ Number of meters ______
Permit#
2
2. Brief Description of Work
3. Attach Drawing(s) of proposed work (if applicable)
Please include dimensions, existing utilities, depths, etc.
Please note- if field modifications are required as approved by the City, an updated as-built drawing is
required.
4. Construction Information:
Estimated Improvements Cost __________
Start of Work (Approx. Date) _____________ Completion of Work (Approx. Date) ___________
Contractor _____________________________ Phone _________________
Contractor Address ____________________ Phone _________________
On-site Contact ________________________ Phone __________________
5. Permit Type:
New Service Change to existing service City Hydrant Usage
6. Request Type:
Installation Retirement Reuse Backflow Required? Yes No
Select type 3/4" 1" 1-1/2" 2" 4" 6" 8" Other
Domestic
Fire
Irrigation
Combination
(fire/domestic)
3
General Conditions and Requirements
In consideration of granting this permit, the undersigned agrees:
1. To accept and abide by all provisions of the most recent City of Winooski Ordinances,
standards, and specifications for construction, Champlain Water District standards and
specifications for construction, and all other pertinent ordinances or regulations that may be
adopted in the future.
2. The City of Winooski is not a member of Dig Safe. For Dig Safe certification, please contact
the City of Winooski Water Resources Manager (John Choate - 802.373.5760).
3. Until the applicant has received written permit approval from DPW, and except as authorized
in the approved permit, no work shall occur in the right-of-way, and no obstacles shall be
placed within the limits of the right of way in any manner that interferes unnecessarily with
the traveling public.
4. All the work herein contemplated shall be done to the satisfaction of the City of Winooski.
5. To notify the Department of Public Works when the work is ready for inspection please
contact City Hall-Public Works at 802.655.6410 or the Utility Manager. Inspections will occur
Monday – Friday during normal business hours (7am-2pm).
6. This permit is valid for thirty (30) days. If the permitted work does not commence within
thirty (30) days a new permit shall be required. In the event that fees increase between the
initial permit and any renewed permit issued subsequently, the applicant is responsible for
paying the difference at the time of reapplication.
All permits must have a final inspection. Failure to contact the City for inspection prior
to backfill of work may require the applicant to uncover or otherwise expose work so
that an inspection can occur.
Applicant Signature ___________________________________ Date ___________________
click to sign
signature
click to edit
4
This section completed by City:
Application Approval:
Additional Permit Conditions (if any)
Approved by ______________________________ Date __________________
Fee Amount (per ordinance schedule) $ ____________
Application Rejection:
Rejected by _______________________________ Date ___________________
Rejection Description:
Last Updated: 6/23/20
s:\public works\public works - water resouces\permits-forms\water service application.docx
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Water Service - Permit Application (City of Winooski)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document