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2. 
3. Water Department
   City of Taylor 23555 Goddard Taylor, MI 48180
4. This form is print only
   Please complete this form by signing in the respective field. Once signed please deliver or mail to the Water Department at City Hall.
8. Permit to connect to sanitary sewer system
9. Sewer Permit Number
   To be completed by the City
10. Plumbing Permit Number
    To be completed by the City
14. Location Address
15. Date Applied
    Date Applied
17. Lot number
18. Subdivision
22. Owner's Contact Information
24. Name
25. Email Address
26. Phone Number
28. Address
30. City
31. State
32. Zip Code
36. Contractor's Information
38. Name
39. Email Address
40. Phone Number
42. Address
44. City
45. State
46. Zip Code
50. 1. New Residental
    2. Existing Residental
    3. Other
51. Qualifying Plumber's Signature
    ____________________________________________________________
53. Wye Location
    ____________________________
54. E. W. N S. of Manhole No.
    ____________________
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