Fillable Applicant must be the property owner (Lancaster County Water and Sewer District)

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Applicant must be the property owner (Lancaster County Water and Sewer District)

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WATER / SEWER TAP PRE-APPLICATION
Name of Applicant:_________________________________________________________________________
THIS MUST BE A 911 ASSIGNED ADDRESS
Address where the tap will be installed:________________________________ _____________ ___ ______
Street City State Zip
Social Security #:________________________ Drivers License #:___________________ ______
State
Telephone number:_______________________ ______________________ __________________________
Home Work Cell
Date of Birth:_______________________________________ __________________________________
Month Day Year Email
Billing Address:______________________________________ _____________________ _____ _________
Street City State Zip
Lancaster County Water and Sewer District (LCWSD) will be responsible for the installation of the water tap.
This will consist of necessary piping and fittings to connect to the water main, a meter enclosure box and a
water meter.
L
CWSD is not responsible for the installation of the water lines from the meter box to the residence or the cus-
tomer cut off valve. A customer cut off valve must be installed on the water line from the meter box to the resi-
dence. This will be the applicants responsibility.
On
ce meter is set ,billing starts. Set Meter:
Yes No
Please give directions to the address where the tap will be installed. Include road names and other significant
landmarks. Also please describe the type of residence such as : modular, mobile home, house or if it is a vacant
lot please state so.
_________________________________________________________________________________________
_
________________________________________________________________________________________
_________________________________________________________________________________________
_
________________________________________________________________________________________
Include map on back if necessary.
Applicant must be the property owner
PLEASE CHECK THE SERVICES TO BE APPLIED FOR:
Residential 3/4 Water Tap: Industrial/Commercial 3/4 Water Tap: Irrigation 3/4 Tap:
Residential Sewer Tap: Industrial/Commercial Sewer Tap:
Sewer Tap Inspection Fee:$ 20.00 ONLY IF SEWER IS SELECTED
REV 12052016
MUST BE PROPERTY OWNER
Please print all items clearly
Applicants Signature
Date
Rates effective as of 02/09/2005
LCWSD Fax Number– 803-285-9574
Please send all faxes to 803-285-9574
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Applicant must be the property owner (Lancaster County Water and Sewer District)

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Completed 30 May 2021

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