City of West Branch
121 North 4^th Street West Branch, MI 48661
(989) 345-0500
(Please print, complete & return to City Hall at address listed above)
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Storm Sewer Tap Application

Date: ______ /______ /__________ Phone #: (            )             -

Applicant's Name: ________________________________________________________

Address:________________________________________________________________

Owner's Name:___________________________________________________________

Address of Property to be Served:_____________________________________________

Storm Sewer Tap Fee:______________________________________________________

                                                                           __________________________________
                                                                                            Applicant's Signature

Date Paid: ______ /______ /__________  Date Inspected: ______ /______ /__________

__________________________________
              Signature of Inspector

__________________________________
                 Clerk's Signature