Bradford Water & Sewer Commission Permit Application
To Tap and/or Extend Water Lines, Increase Usage and/or Reconnect Water Line
Please print this form - complete the following information and mail to:
Bradford Water & Sewer Commission
PO Box 603 - Bradford, VT 05033
Applicant’s Name: __________________________________________________________
Applicant’s Address: __________________________________________________________
__________________________________________________________
Usage Location: __________________________________________________________
__________________________________________________________
Type of Usage (circle one) Residential Commercial Industrial Other
Needs: _____________ gallons per day. Sprinklers ________ volume/pressure ________
Size of Line: _____________ Hydrant ________ volume/pressure ________
Other ________ volume/pressure ________
Additional comments about needs: _____________________________________________
_____________________________________________________________________
_____________________________________________________________________
I/We understand and agree to abide by the rules, regulations, and decisions of the Bradford Water & Sewer Commission. I certify that the applicant and the property owner are one and the same.
Date: _______________ _________________________________________
Applicant’s signature
Date: _______________ _________________________________________
Applicant’s signature
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Water Department Use Only
APPROVED DENIED
Date: _______________ _________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Permit is valid for 2 years from the date of approval.