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2. Property Owner
3. Property Owner Phone Number
5. Applicant
6. Applicant Phone Number
7. Applicant E-Mail Address*
   *If preferred method of contact
9. Contractor
11. Site Address
15. SERVICE LINE (BUILDING SEWER) CONSTRUCTION OR MODIFICATION
17. Nature of Work
    *NOTE: The disconnection and pipe plug system shall conform to the "Standard Specification for Water and Sewer Construction in Illinois" and City of Pontiac codes.
19. Indicate the type of sewer water-tight pipe plug to be used:

    1. PVC Plastic
    2. Rubber Gasketed Twist Type
    3. Other
20. (If other, please specify)
22. Size plug needed

    1. 4 Inch
    2. 6 Inch
    3. 8 Inch
    4. Other

    NOTE: Pressure rated pipe must be used within 10 ft of a water line or service
23. (If other, please specify)
25. I WILL NOTIFY THE CITY OF PONTIAC SEWER DEPARTMENT AT 815-844-5574 AT LEAST 24 HOURS PRIOR TO STARTING DEMOLITION AND WILL CALL FOR AN INSPECTION PRIOR TO BACKFILLING THE SEWER PLUG.
27. A site drawing of the proposed sewer service disconnect is required, showing all existing sewer facilities between the main and existing service line disconnect.
29. eSign- First Name
30. eSing- Last Name
31. Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field