Town of Salisbury

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

 

Town of Salisbury.

 

In applying for this permit, the undersigned agrees to the following conditions:

 

1.                  Accept and adhere to all provisions of the Town of Salisbury Sewer Service By-Law, the Regulations Regarding Access Fee For Connecting to Public Sewer and all future by-laws and regulations that may apply.

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.

 

Signed___________________________________________ Date____________________

 

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_____________

 

Notes:  __________________________________________________________________________