Fillable ALLOCATION APPROVAL APPLICATION (Town of Milton, Vermont)

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ALLOCATION APPROVAL APPLICATION (Town of Milton, Vermont)

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The ALLOCATION APPROVAL APPLICATION (Town of Milton, Vermont) form is 2 pages long and contains:

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  • 22 check-boxes
  • 29 other fields

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File type: PDF

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Page 1 of 3
TOWN OF MILTON
WATER & WASTEWATER DEPARTMENT
ALLOCATION APPROVAL APPLICATION
For Office Use Only
Date Received:
Permit Number:
Parcel Number:
Amount Due:
Date Paid:
Amount Paid:
APPLICATION FEE: $ 25.00 for Water / $25.00 for Wastewater
Applicants Name: __________________________________________ Date: _____________________ 20 _____
Mailing Address: _______________________________________________________________________________
_____________________________________________________________________________________________
Phone #: ___________________________________________ FAX: ______________________________
Email Address _______________________________________________________________________________
Property Owner: _______________________________________________________________________________
Consultant Name: ___________________________________________ Phone #: ___________________________
Fax #: __________________________________ Email: _______________________________________________
Project Location: Tax Map/Parcel ID
Type of Project: ____________________________________
For Single Family Residences Only, how many bedrooms will the structure have? ______________ Bedrooms
Water Allocation Request (Attach Engineers Calculations): (Gallons per Day)
Wastewater Allocation Request (Attach Engineers Calculations): _____________________ (Gallons per Day)
Please provide the following information about your project:
1. Is the request for a connection within a current service area? Yes No
2. Is there an existing building on the lot? Yes No
If yes, will it be used for the project? Yes No
3. Is there a water supply or septic system failure? Yes No
Page 2 of 3
If yes, include an engineer or site technicians’ statement.
4. If #2 is yes, is the building already connected to municipal water or sewer Yes No
For development or PUD applications only, please answer the following questions:
5. For Water & Wastewater Main extensions, do you propose the connection
to be publicly or privately owned? Public ____ Private ____
6. If private, do you propose to maintain the infrastructure? Yes ____ No ____
NOTE: If you choose to maintain the water infrastructure, you will need to apply to the State Water Supply
Division for a permit to operate a public water system! If you choose to have the Town maintain the water
and or wastewater infrastructure, a permanent maintenance agreement will be required with the Town.
If the proposed project is not within a current service area as indicated in the Water and Wastewater Ordinances,
please answer the following:
7. Approximately how close is the nearest service area to the project location?
8. Do you intend to design and construct the necessary infrastructure? Yes No
If this request is for a project/building not yet existing, please answer the following:
9. Is DRB approval necessary? Yes No
If no, please provide a statement from the Planning & Zoning Office
10. If yes to No. 9, have you applied for DRB approval? Yes No
11. If yes to No. 10, do you have conditional approval from the DRB? Yes No
(If yes, please supply a copy of the facts & findings)
As required by the Water & Wastewater Ordinances, the following information must be submitted with this request:
1. A Registered Professional Engineer’s (RPE’s) calculations for the water/wastewater volume, including
peak, maximum and average day flow rate, wastewater strength and any other characteristics determined to
be appropriate by the Water & Wastewater Department. RPE calculations are not required for individual
single family dwelling/unit requests and residential requests less than 1000 gallons per day, as determined
by the Water & Wastewater Department.
I/We certify that the calculations and information above is correct to the best of my/our knowledge:
Calculated By: 20
(Engineer Signature)
_____________________________________________
(Engineer Print)
Applicant: 20
(Applicant Signature)
________________________________________________
(Applicant Print)
I/We authorize the above applicant and engineer to act on our behalf:
Property Owner: 20
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Page 3 of 3
(Property Owner Signature, if other than applicant)
Approval Granted By: 20
(Designated Town Official Signature)
Expiration Date: ________________________ 20____
Extension Request Date: __________________ 20____
Extension Granted By: _________________________________________ __________________ 20__________
(Designated Town Official Signature)
New Expiration Date: _______________________ 20____
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ALLOCATION APPROVAL APPLICATION (Town of Milton, Vermont)

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Completed 19 January 2021

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