This form must be filled in and submitted to Guernsey Water prior to the completion of plumbing installations, alterations, and before underground service pipes are covered. No compliance certificates will be issued until all work has been inspected. Please note that Guernsey Water require permission from the Environment Department to excavate a public road.

Name of owner of site

Address of site

Telephone

Nature of work

Service pipe ready for inspection (date)

Internal plumbing ready for inspection (date)

Name of plumbing contractor