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2. 
4. Application for Storm Drain Connection Permit

   Use this form to request a permit to install and connect a storm drain to the City's storm drain system.

6. Applicant Contact Info:
8. Applicant Name*
9. Ownership Status

   Owner, Lessee, etc.

11. Street #*
12. Street # Suffix
13. Street Name*
15. Phone #*
16. Email Address*
18. Property Information:

    Fill out only if different than above. 

20. Street #
21. Street # Suffix
22. Street Name
24. Purpose for the Storm Drain*
25. Proposed Date of Work*
    Proposed Date of Work
27. Contractor Information:

    Contractor who will perform the proposed work.

29. Contractor Name*
30. Contractor Address*
32. Contractor Phone #*
34. Terms

    By submitting this application, you agree to the following terms:

    1. To accept and abide by all provisions of Ordinance No. 18-213 of the City of Westfield and all other pertinent ordinances or regulations that may be adopted in the future.
    2. To maintain the storm drain at no expense to the City.
    3. To notify the Department of Public Works or its agent when the storm drain is ready for inspection and connection to the public storm drain, but before any portion of the work is covered.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field