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Water & Sewer Tap Application Revised 1/18/2019 Page 1 Water & Sewer Tap Application 101 N. 4th Street / P. O. Box 1030 Douglas, Wyoming 82633 [PHONE REDACTED], Fax: [PHONE REDACTED] Water Tap Size: 1 inch 1 ½ inch 2 inch Other Sewer Tap Fire Suppression Applicant’s Name: Application Date: Address: Phone: Contractor’s Name: Physical Location of Tap: Within City Limits Outside City Limits NOTES TO APPLICANT 1. Separate permit for street excavation may be required also, except for locations in unimproved streets. 2. Work will be in accordance with the specifications of the City and instructions of the Director of Public Works (358-9750) and/or Building Official (358-2132). 3. Applicant will give the City 24 hours notice before tap or inspection is needed, and will provide proper safety equipment for the work that will be performed. (Phone 358-2132) 4. WATER a. Applicant will excavate for tap, service line and meter pit. Will furnish pit, yoke and all other materials need for the tap. The City will make the tap and install meter. For larger sizes applicant will furnish all labor and materials, with installation under supervision of a master plumber. 5. SEWER a. Applicant will give the City 24 hours notice before tap, materials or inspection are needed, and will provide proper safety equipment for the work that will be performed. (Phone 358- 9750) b. Applicant will furnish all labor and materials, with installation under supervision of a master plumber. IN CONSIDERATION OF THE ISSUANCE OF THIS PERMIT, I AGREE TO COMPLY WITH THE RULES AND REGULATIONS OF THE CITY OF DOUGLAS. Signature: Date: SIGN