2. Date*
   Date

3. Bristol Water & Sewer Dept. SEWER Permit APPLICATION

5. LOCATION & DETAILS OF THE PROPERTY:
7. Service Location with House #*
8. Lot #
10. Property Owner Name (s):*
11. Owner's Phone #*
13. CBYD #*
14. CBYD START DATE*
    CBYD START DATE
16. INFORMATION ABOUT PLUMBER:
18. Plumber's Name*
19. Plumber's Phone #*
21. License No: P-1 or P-7*
22. LICENSE EXP. DATE*
    LICENSE EXP. DATE
23. Upload Plumber's License*
24. Upload Plumber's Driver's License*
26. Please describe the proposed work to be done:*

28. A SEWer permit can only be issued to a licensed plumber who holds a valid P-1 or P-7 license.  Said license holder must be on job site at all times.

    BY SIGNING THIS FORM, I AM FAMILIAR WITH THE STANDARD SPECIFICATIONS OF THE DEPARTMENT AND AGREE TO FOLLOW THE RULES & REGULATIONS OF THE BRISTOL WATER & SEWER DEPARTMENT.                          

      ALL NEW SEWER CONNECTIONS REPLACING SEPTIC TANKS/HOLLOW LEACHING STRUCTURES/CESSPOOL, ETC., MUST OBTAIN A PERMIT FROM BRISTOL BURLINGTON HEALTH DISTRICT.  THESE PERMITS ARE REQUIRED PRIOR TO ISSUANCE OF PERMIT.

    
    

30. IS THIS A NEW SEWER CONNECTION REPLACING SEPTIC TANKS/HOLLOW LEACHING STRUCTURES/CESSPOOL, ETC. ?*

    1. Yes, I have an issued permit by the BBHD.
    2. No, I did not need an issued permit by BBHD.
31. Confirmation of Excavation Permit from Engineering is needed*

    1. Yes, I contacted the Public Works Dept.
    2. No, I need to contact the Public Works Dept. and will do so before finalizing this permit application.
33. PLEASE READ OUR STANDARD SPECIFICATIONS BEFORE FINALIZING THIS PERMIT APPLICATION.
    STANDARD SPECIFICATIONS. By signing this application I acknowledge that I am the Licensed Plumber and have reviewed the standard specifications.
34. Standard Specifications Acknowledgement*

    1. By clicking this box you acknowledge that YOU have READ and UNDERSTAND all of the STANDARD SPECIFICATIONS and will assure that everyone working with and for you will adhere to the same.
36. LICENSE HOLDER MUST BE ONSITE WHILE WORK IS PERFORMED - PER CT STATE STATUTE 20-341*

    1. CT GENERAL STATE STATUTE 20-341 requires the Department of Consumer Protection and the Commissioner of Consumer Protection get notified that work is being performed without the licensed holder present.
37. INSPECTIONS MUST BE SCHEDULED IN ADVANCE OF ANY WORK PERFORMED

    1. By checking this box you acknowledge that all work must be scheduled in advance and inspected by a BWSD representative. Failure to schedule an inspection and any work performed without said inspection will be required to be excavated for inspection before it will be accepted by the BWSD.
41. Plumber's Signature and Acknowledgement*
42. Date*
44. Email*
45. Payment must be made by check or cash before permit approval. Please allow up to 4 business days for processing. Do not start work until permit has been issued.
49. OFFICE SPACE ONLY
51. Service Type
    -- Select One --CommercialResidentFire
52. Account #
53. Total Amount Due
54. CID
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field