Application for Fire Hydrant Permit

Applicant*
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Address
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Your Email*
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Phone*
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Lic. Plate No.*
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Use of Water
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Start Date*
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Expiration Date*
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Backflow Prevention (Choose One)*

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Permit Requested*

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Total Permit Fee
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Signature (Please type in full name)*
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Today's Date*
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The Electronic Signatures and Records Act (ESRA) provides that "signatures" made via electronic means will be legally binding just as hand-written signatures now are. The law also enhances and clarifies the authority of government to create and retain records in computer produced electronic form. There is now no doubt that electronic records have the same legal force as those produced in other formats such as paper and microfilm.


PERMITTED HYDRANTS: Boyack Road & Tanner Road at Route 146A, unless otherwise permitted by the CPWA.


Specially Authorized Hydrant #/Location
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