Residential, Commercial, Industrial Sewer Service Application
I/We________________________________________________, being the owner(s) of the property
Name of Owner(s) only
located at _____________________________________Map #_____Lot/Parcel #_____ request a permit
to install and connect to public sewer for the following purpose: (check one)
____Single family home ____Multi family home ____Mobile/Manufactured home
____Apartment Bldg ____Commercial Bldg ____Other (Specify)
If you are applying for a condominium or apartment building connection, please indicate the number of
Units ______. The maximum number of present or future residents at this address is_______.
I attest that ____________________________________(piping contractor) is licensed to install pipe in the
In applying for this permit, the undersigned agrees to the following conditions:
Accept and adhere to all provisions of the Town of
2. When piping is complete and while all work is visible, request that the Sewer Department inspect, approve and permit connection to public sewer.
3. Maintain all owner sewer related piping at no expense to the Town.
4. No stubs or piping will be installed for an existing or future building without prior approval of the Sewer Department.
Applicant’s billing address______________________________________________________________
Approved by: ______________________________ Date_____________________
(Sewer Department Official)
Hook up fee paid: $_____________ Check #____________
Note: By copy of this application, the Health Agent is requested to verify that the septic tank at the above address is filled before or subsequent to connection to public sewer.
Pipe Diameter__________Pipe Length___________Hookup Date_____________