Project Name: Phase/Section:
Property Owner(s): Submittal Date:
PIN(s) or PID(s):
Submitted By: Phone Number:
Engineering Firm: Engineer:
Mailing Address:
GENERAL INFORMATION -
An extension of existing water/sewer (circle) line(s) to provide service to:
(provide a brief description of the facility and the size/type of extensions proposed)
No. of Lots or Units:
Estimated Demand Per Day: gallons per day
Adjacent Street(s) or Road(s):
No. of Lots or Units:
Estimated Demand Per Day: gallons per day
Adjacent Street(s) or Road(s):
Does the project require a pump station:
[ ] Yes [ ] No
If yes, check one: [ ] Proposed
[ ] Existing
AVAILABILITY INQUIRY
Sewer Project
EXTENSIONS WILL REQUIRE STATE APPROVAL
Water ProjectWater Project
1 of 1
REVISED
1/23/2020