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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. Fees:

   Application Fee - $150

8. Applicant Contact Info:
10. Applicant Name*
11. Ownership Status

    Owner, Lessee, etc.

13. Street #*
14. Street # Suffix
15. Street Name*
17. Phone #*
18. Email Address*
20. Property Information:

    Fill out only if different than above. 

22. Street #
23. Street # Suffix
24. Street Name
26. Purpose of Storm Drain Connection*

    Purpose of storm drain connection, including what areas (i.e. roof, driveway, parking lot, field, etc.) will drain into the proposed system.

27. Proposed Date of Work*
    Proposed Date of Work
29. Sketch Upload*

    Sketch of the proposed connection that shows the location, size, depth, and construction material(s).

31. Contractor Information:

    Contractor who will perform the proposed work.

33. Contractor Name*
34. Contractor Address*
36. Contractor Phone #*
38. 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:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field