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Sanitary Sewer Lateral Connection/Disconnect Permit Application

Attention Westfield applicants: As of January 1, 2018, the IURC has approved a $1000 connection fee per equivalent dwelling unit (EDU).

Primary Contact Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact Email

Project Name

Project Description

Requested Service Location

Location Type

Utility

Service Address (legal address, not intersection)

City

State

Zip

Subdivision (if applicable)

Section (if applicable)

Lot # (if applicable)

Township (optional)

County (optional)

Property Owner and Billing Information

Check if Billing Address is the same as the Requested Service Address

First Name

Last Name / Business Name

Address

City

State

Zip

Phone Number

Contractor Information

Contractor/Company Name

Contractor License #

Address

City

State

Zip

Phone Number

Individual Agent/Applicant First Name

Individual Agent/Applicant Last Name

Individual License #

Individual Agent/Applicant Phone

Permit Type

Upload Supporting Documentation

Allowed File Types: doc,docx,xls,xlsx,dwg,pdf,jpg,jpeg,tiff,tif
Combined File Size Limit: 15MB

Special Comments (optional)

Terms and Conditions

By clicking below, the applicant agrees to comply at all times with Terms and Conditions for Sewage Disposal Service, Sanitary Standards, and all other applicable rules, regulations, and standards (Local, City, State and Federal).

I agree to the Terms and Conditions and I have been authorized by the property owner to perform the work described in this application