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2. 
5. PUBLIC INFRASTRUCTURE CONNECTION PERMIT
7. Submittal Requirements are the following:

   1)  A site plan or a utility plan showing all the needed information including depth, material and location of the infrastructure.
   2) Additional information may be required.

9. Project location / address*
10. Type of Job*

    1. Commercial
    2. Residential
12. Project county*
13. Project subdivision / survey*
14. Project block and lot*
16. Scope of work*
    -- Select One --ADD NEW WATER SERVICEADD NEW SANITARY SEWER SERVICEADD NEW DRAIN SYSTEMEXPAND EXISTING DRAIN SYSTEMADD NEW FIRE HYDRANT
17. Water Service Size (If applicable)*
19. Curb to be cored?*
    -- Select One --YES, BY OWNERYES, BY CONTRACTORNO CURB TO BE CORED
20. If so, please provide the diameter of core cut (in inches) and the number of core cuts to be made

    View the Private Drain Pipe Details

24. PROPERTY OWNER INFORMATION
26. Is the applicant the property owner? (If not, then provide a property owner representation declaration)
    -- Select One --YesNo
28. Applicant name*
29. Applicant address*
31. Applicant e-mail address*
32. Applicant phone number*
36. CONTRACTOR INFORMATION
38. Contractor name*
39. Contractor address*
41. Contractor e-mail address*
42. Contractor phone number*
44. Attachment*
46. Electronic Signature Agreement*

    By checking the "I agree" box below you agree and acknowledge that

     1) Your application will not be signed in the sense of a traditional paper document

    2) By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.

    3) You may still be required to provide a traditional signature at a later date

    4) You acknowledge and understand that this application will take up to five working days to review and process.

    1. I agree.
48. Electronic Signature*
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field