What kind of development is/will be on the property?

Residential  

Commercial--Provide a detailed, to-scale floor plan  

Industrial  

Wet Industrial--Provide GPD and BOD

Number of Units:

Separate Water Meter (Yes/No)?:

Service Line Length (ft):

Building Permit No:

Zoning Clearance No:

What type of permit are you requesting?

New connection with sewer to vacant property Service line replacement in same trench Service line replacement in new trench Service line extension (adding to existing service line) Existing structure not connected to sewer New construction with no sewer to property (Other)  

Other:

Property Information (complete at least one):

Address
Map & TL No.
Subdivision, Lot #, & Street Name

Applicant Information (required):

Name
Mailing Address
City, State Zip
E-mail
Tel
FAX

Owner Information:

Name
Mailing Address
City, State Zip

 

Additional information you'd like to bring to our attention:

Please contact me as soon as possible regarding this matter.