HTML Preview Plumbing Application & Permit Receipt page number 1.
Permit No. ___________
Receipt No.___________
Fee $
______________
$_________
PLUMBING APPLICATION and PERMIT
TO THE PLUMBING INSPECTOR:
The undersigned hereby applies for a permit to do and install the following plumbing on the premises
hereinafter described, the work to conform to the Wisconsin State Plumbing Code, in the performance
of which all parties hereto agree to and are bound by said statutes.
PROPERTY DESCRIPTION
CONSTRUCTION SITE ADDRESS
NAME OF OWNER_______________________________________________ PHONE _____________________
FOR THE FOLLOWING WORK:
WATER CLOSETS
CLOTHES WASHERS
CATCH BASIN
LAVATORIES
LAUNDRY TRAYS
BRADLEY SINK
BATHTUBS
WATER HEATERS
BIDET
SHOWER STALLS
FLOOR DRAINS
BAR SINK
KITCHEN SINKS
SUMP PUMPS
ICE CHEST
DISPOSALS
URINALS
STORM SEWER
DISHWASHERS
SERVICE SINKS
ROOF DRAINS
DRINKING FOUNTAINS
WALL HYDRANTS
GREASE TRAP
EJECTOR
ESTIMATED TOTAL COST
$
18.05 Plumbing Permits and Fees. (1) WHEN PERMIT IS REQUIRED. (a)No plumbing shall be done in the Village of Little
Chute without a permit being first issued therefore by the Building Inspector, and the paying of the proper fee as
hereinafter provided. Such permits may be issued only to persons duly licensed to do plumbing under the laws of
Wisconsin, provided, any person actually owning and occupying a single-family residence, may do plumbing therein without
license and bond, although such person shall secure a permit and work shall fully conform with all requirements as to
workmanship, design and materials, and provided further, that any person assisting such owner shall be a licensed master
plumber. Any plumbing shall conform to all provisions of the state law and codes, and ordinances of the Village of Little
Chute.
The Applicant, Either a Licensed Master Plumber (or a Property Owner doing work only within their own home in
which they currently reside) and having paid the required fee evidenced by Treasurer Receipt, is hereby granted
authority to do Plumbing Work indicated on the premises and as per application, here in above stated, and in full
compliance with all Village Ordinances and State Plumbing Code, as governing. Please send fees and two copies of
application to the inspector.
PLUMBER _______________________________________________________ PHONE ________________
ADDRESS ________________________________________________________ CITY ___________________
SIGNATURE ______________________________________________________MP # ___________________
INSPECTOR ______________________________________________________ DATE ___________________