Application For Sewer Tapper''S License - Water Branch Service License Form
ADVERTISEMENT
1.
CITY OF FAIRFIELD, OHIO
APPLICATION FOR
SEWER TAPPER'S LICENSE
WATER BRANCH SERVICE LICENSE
NAME
HOME ADDRESS
HOME PHONE
(
)
COMPANY NAME
COMPANY ADDRESS
BUSINESS PHONE (
)
LICENSE APPLIED FOR:
[ ] Sewer Tapper's
[ ] Water Branch Service
I hereby make application for the license(s) as indicated above. The information presented here is correct and true to the best of my
knowledge.
Signature of Applicant
Application Date
DO NOT WRITE BELOW THIS LINE
(For Office Use Only)
VERIFICATION INFORMATION
EFFECTIVE DATE
EXPIRATION DATE
[ ]
$5,000 Performance Bond
[ ]
$100,000 Liability Insurance
[ ]
Workers' Compensation
FEE INFORMATION
FEE PAID
RECEIPT NUMBER
[ ]
$30.00 - Sewer Tapper's License
[ ]
$30.00 - Water Branch Service License
LICENSE INFORMATION
DATE ISSUED
LICENSE NUMBER
Sewer Tapper's License
Water Branch Service License
Renewal:
[ ] yes
[ ] no
Rev. 10/98
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business