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2. 
4. Property and Owner Information:
6. Owner Name, as it appears on deed *
7. Business Name (If Applicable)
9. Street #*
10. Street # Suffix
11. Street Name*
13. Phone #*
14. Email Address*
16. Contractor Information:
18. Contractor Name*

    Contractor who will perform the proposed work

19. Contractor Address*
21. Contractor Phone #*
23. Brief Description of Repair
25. 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 reconnection to the public sewer, but before any portion of the work is covered at 572-6226.

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

    This field is not part of the form submission.

31. Submit

* indicates a required field