GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
DEPARTMENT OF PLANNING AND NATURAL RESOURCES 
DIVISION OF PERMITS 
STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 
APPLICATION for PLUMBING PERMIT 
(Please Print Clearly) 
Parcel Identification Number (PIN) 
Class of Work 
Owner of building:  
 ☐New ☐ Alteration
Owner mailing address:  
☐Addition ☐ Repair
Use of Building 
Plot No. 
Estate 
Quarter 
☐Private or Rental Dwelling ☐ Store/Warehouse
House No. 
Street 
☐Restaurant ☐ Bar
(If Applicable) 
Office ☐Other 
General statement of the proposed work: --------------------------------------------------------------------------------------------------------------------
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Description of the proposed work and information related thereto: 
1.
No. of bedrooms
; bathrooms 
2.
No. of plumbing fixtures (existing plus new): Kitchen sinks
Toilets 
Lavatories 
Urinals 
Bathtubs  
Showers  
Other (specify)
3.
Will waste be discharged to the city sewer?
Yes 
No, if yes. A sewer connection ☐ Exists  Is requested ☐
 
4.
Septic tank for this installation: Exists ☐  New  ☐
5.
Septic tank inside dimensions:
ft. long x 
ft. wide x  
ft. high (to overflow) x 7.5=  
gal. 
6.
Capacity of seepage tank:
gallons; or area of absorption field:  
sq. ft. 
7.
Will installation use portable water? ☐Yes ☐ No. If yes, what is the size of the pipe connection or to be
connected to the city main? 
8.
Will installation use salt water? ☐ Yes ☐ No. If yes, what is the size of the pipe connected to the city main?
inch. Connection: ☐ Exists ☐ Is requested
Will the proposed work encroach on public rights-of-way or on the property of others? 
Total estimated cost of the proposed work: $ 
Has work been started? 
Plumber who will do this work:  
 License No.: 
Signature of applicant:  
 Date signed:  
Phone No.: 
Note: Permit will be issued in the licensed plumber’s name, who is authorized to do the work on behalf of the owner. 
 Seal and Signature of USVI Licensed Plumber  
☐ 
Location of Work