Village Hall Phone: 330-427-6721
Fax: 330-427-8088 Village Of Leetonia VILLAGE
OF LEETONIA APPLICATION TO WORK VILLAGE STREET___________________________________________________________________________________ HOUSE NUMBER____________________________________________________________________________________ MAILING ADDRESS PROPERTY ADDRESS NAME:_________________________________________NAME:____________________________________________ STREET:________________________________________STREET:__________________________________________ CITY:__________________________________________CITY:____________________________________________ ZIP CODE:_______________________________________ZIP CODE:_________________________________________ HOME PHONE:____________________________________WORK PHONE:_____________________________________ Description of
work to be performed: If the Village supplies the culvert pipe, I, _________________________________________will reimburse the Village upon receipt of bill from Village. Property owner's signature_____________________________________________________ Has the work area been marked with a stake or a flag?______________________________ Please include a sketch of the property. (See instructions for details) CALL
2 WORKING DAYS ADMINISTRATOR/STREET
SUPERINTENDENT INSPECTION DATE:______________________________ PERMIT NUMBER:__________________________________________________________________ VALID FOR 90 DAYS FROM THIS DATE:________________________________________________ |