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3. Date of Application*
   Date of Application
5. Address of work*
6. Lot Number
8. Sanitary Sewer Pass Through Fee

   *IF APPLYING FOR A SANITARY SEWER TAP IN PERMIT, PLEASE MAKE SURE TO INCLUDE THE ADDTIONAL PASS THROUGH FEE INTO PAYMENT.  *See Engineering Fee Schedule link below. 

10. Meter Size/Length *
    -- Select One --5/8 Inch and 3/4 inch1 inch1.5 inch2 inch3 inch4 inch6 inch8 inch
11. Type*

    1. BOTH - Water and Sanitary Sewer Tap
    2. Water Tap
    3. Sanitary Sewer Tap
    4. *TCA Capacity Fee for Sanitary Sewer - Must be included with all Sanitary Sewer Taps
13. Name*
14. Email Address
16. Address
18. City
19. State
20. Zip Code
22. Phone Number*
23. Fax Number
25. Fee Schedule
    Engineering Fee Schedule
26. Payment

    After you submit this form you will be automatically redirected to the online payments page.

28. Please Read the Below Before Submitting
    Rules and Regulations for Tap In Permit
30. Electronic Signature Agreement*

    By checking the "I acknowledge" 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, and 3) you may still be required to provide a traditional signature at a later date.

    1. I acknowledge.
32. Electronic Signature
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field