Worksheet for
Water & Sewer Services
Evanston Water Department
555 Lincoln Street
Evanston, IL 60201
(847)866-2942
Application #
_____WSNS________
Received______________
Application Procedure: Please complete this worksheet and a Building permit application.
Submit this application along with a drawing showing the water and sewer services,
parkway trees if applicable, sidewalk, driveway and where the service will enter the building.
The Plumbing Inspector and the Water/Sewer department will review the submission and drawing.
Once it is approved by both departments, the Water Department will assess the permit fees; the
Building Department will notify you to pay and pick-up the permit.
If a parkway or street opening is needed please see the Traffic Engineering Office.
Property Owners Name:_________________________Phone Number____________________
Company Name:________________________________________________________________
Contact Person: _____________________________Phone Number: _____________________
Plumber's Name: _________________________License #:______________________________
Address of Construction: ________________________________________________________
Building Use (circle) Residential – Multi-Family – Commercial
Requested size of Sewer Service:
Tap diameter ____________ Length__________Feet
Requested size of Storm Service:
Tap diameter ____________Length__________Feet
Storm Water Detention System (circle)
yes
no
Vortex Restrictor (circle) yes
no
Requested size of Water tap/Service_______Fire Service (circle) Yes No (Yes see Attachment A)
What size is the Domestic line________ Estimated maximum domestic Flow ____________GPM
Is a water meter desired? (circle) Yes - No
Date the work start _________________________
To be completed by Water/Plumbing Department
Approved Tap Size ______________Approved Sewer Tap Size ____________
Domestic Meter ________________Fire Line Meter _____________
Vortex Restrictor_______________Labor_____________________
Storm water detention ______________Total Cost__________________
Disconnects: Water__________________Sewer_________________
Approved Signatures_____________________
Plumbing Inspector
___________________________
Water Department
OVER
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Page 2 of Worksheet for
Water & Sewer Services
Evanston Water Department
555 Lincoln Street
Evanston, IL 60201
(847)866-2942
Job Address: _____________________________________________________________
Owner: _________________________________________________________________
Phone No.: _____________________________________
Address: ________________________________________
Plumbing Contractor: ______________________________________________________
Phone No.: _____________________________________
Address: ________________________________________
Scope of Work (be specific):
_______________________________________________________________________
_______________________________________________________________________
Contract Price: $ __________________________________________________________
I HEREBY CERIFY THAT THE ABOVE LISTED WORK WILL BE DONE BY MY COMPANY, ANY
ADDITIONAL WQRK WILL REQUIRE ADDITIONAL PERMIT FEES,
AND ALL WORK IS TO BE INSPECTED.
X ____________________________________ X ________________________________
Signature of Supervising Plumber
State License # or Drain Layer #
Water Service Drawing Requirements
Single Family Residential
New and Upgrade
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1.
2.
This drawing does not have to be drawn to scale.
The drawing must show the following items.
a.
The house
b.
Location of existing water & sewer
c.
Location of new water & sewer
d.
The separation between the new water and sewer (must
be minimum of ten feet).
e.
Any trees on the parkway (must be a minimum of ten
feet).
3.
If a corner house, you must show which street you are coming
off.
a.
Indicate front of the house.
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