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Reimbursement Program Request for Eligibility Determination

  1. VILLA PARK SEWER REIMBURSEMENT PROGRAM
    REQUEST FOR ELIGIBILITY DETERMINTATION

  2. Please select from the following (check all that apply):*

  3. If you chose "It has been determined by a Village inspector that a driveway, stairwell, or other area drain on my premises is connected to the Village’s sanitary or combined sewer system and financial assistance for the correct work is requested", please select one of the following:

  4. If you chose "It has been determined by a contractor that a broken or collapsed building sewer has been located within the Village right-of-way in the street or parkway", please fill in the questions below:

  5. Please select one of the following:

  6. If you chose "I wish to initiate point repairs or complete replacement of the building sewer", please select one of the following:

  7. Therefore I/we request to be granted eligibility to receive reimbursement for repair or replacement fo the building sewer located within the Village right-of-way.


    I UNDERSTAND THAT ELIGIBILITY IS NOT A GUARANTEE OF FINANCIAL ASSISTANCE.

  8. Leave This Blank:

  9. This field is not part of the form submission.