2. $40 upfront fee of cash or check must be obtained at Village Hall before permission granted. 

   Checks can be mailed to:
   Village of Little Chute
   108 W Main St
   Little Chute WI  54140

4. Individual or Company Name
6. Contact Name
7. Email
9. Home Phone
10. Cell Phone
12. Individual or Company Address
14. Address2
16. City
17. State
18. Zip
20. BILLING INFORMATION
22. Check Box if Same as above

    1. YES
24. Address1
26. City
27. State
28. Zip
30. Contact Name
31. Contact Phone
33. FAX
35. Contact Email
37. Primary Use of Water

    1. Agriculture
    2. Construction
    3. Landscape
    4. Other, detail below
39. IF Other Please Explain:
41. Name of Authorized Representative Submitting this Request

43. By submitting this application I confirm that I am an authorized representative of the company, and that I have read and understand the Bulk Water Program requirements and operating instruction. Further, I understand that failing to comply with hydrant operating procedures, failing to provide a monthly usage form for all permitted vehicles, accessing unauthorized hydrants in the Village of Little Chute, and/or account delinquency can result in permit privileges being revoked.

45. Submit*

    1. I agree
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field