Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
SEWER AVAILABILITY APPROVAL
Associated Permits:
Site Address:
Applicant’s Information:
Name:
Mailing Address:
Type of development to be supplied by the Sewer System:
Single-family residential Multi-family residential Commercial Other (describe)
Number of connections necessary for proposal:
Signature of Applicant: Date:
To be completed by authorized sewer system personnel:
The above named applicant has submitted a development permit application requiring verification of a valid sewer
connection. Please review the information provided and determine if all appropriate fees have been paid and the
connection is authorized.
System Name: __________________________ Tax Parcel #: ______________________________
Site Location: ____________________________________________________________________
This system has authorized a connection and will provide service to the site and project listed above:
Yes _____ No ______ Connection # (if applicable) ___________________________
This property is located at the address listed at the top of this page. All fees have been paid and the connection is authorized.
Certified by (Signature / Title):_________________________________________ Date: ____________
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signature
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