Hydrant Flow Test Application printable pdf download

Hydrant Flow Test Application

HYDRANT FLOW TEST APPLICATION-SEABROOK NH

Please bring completed application and $50.00 fee to the water office, or mail to:

Seabrook Water Department, 550 Rte 107, PO Box 456, Seabrook, NH 03874 (603) 474-9921

DATE:

FEE:

HYDRANT FLOW TEST LOCATION:

(Street Name/Number if applicable)

MAP:

LOT:

SEQ:

DATE/TIME OF TEST:

Email:

APPLICANT'S NAME:

BUSINESS NAME:

MAILING ADDRESS:

CONTACT NAME:

PHONE #:

NOTE: PLEASE ATTACH A COPY OF YOUR CERTIFICATE OF INSURANCE

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agree, I will not hold the Seabrook Water Department

Business Owner Signature

responsible for any damages to property, which may be incurred during, or as the results of this hydrant flow test.

CHECK PAYABLE TO 'SEABROOK WATER DEPARTMENT' MUST ACCOMPANY THIS APPLICATION

Please call: Curtis Slayton, Water Superintendent at (603) 474-9921 to set up your appointment.

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Please do not write below this line - office use only

RECOMMENDATION OF WATER SUPERINTENDENT:

Date

BOARD OF WATER COMMISSIONERS:

REASON FOR DENIAL:

Chairperson of the Board

DATE APPROVED:

Hydrant Flow Test Application