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2. Permit Number*
4. Date of Application*
   Date of Application
6. Address of work*
7. Lot Number
9. Meter Size/Length *
   -- Select One --5/8 Inch and 3/4 inch1 inch1.5 inch2 inch3 inch4 inch6 inch8 inch
10. Type*

    1. Water Tap
    2. Sewer Connection
    3. Water Main Extension
    4. Sewer Main Extension
12. Name*
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Phone Number*
22. Fax Number
24. Fee Schedule
    Engineering Fee Schedule
25. Payment

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

27. Please Read the Below Before Submitting
    Rules and Regulations for Tap In Permit
29. 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.
31. Electronic Signature
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field