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Application for Utility Connection Sewer
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SECTION 1 - SITE INFORMATION
No
Street Address / Owner
*
Street Name
*
Street Number
*
Parcel Number
Zone
*
Street Name
*
Street Number
*
Parcel Number
Zone
Unit Number
*
SECTION 2 - OWNER INFORMATION
Residential
Non-Residential
Owner’s Name / Owner’s Agent Name
Street Number
Street Name
City
State
Zip Code
Telephone
*
Email
*
SECTION 3 - APPLICANT INFORMATION
Same As Owner
Applicant Name
Street Number
Street Name
City
State
Zip Code
Telephone
Email
SECTION 4 - MAILING ADDRESS
Same As
--Select--
Site Information
Owner Information
Applicant Information
Street Number
Street Name
City
State
Zip Code
SECTION 5 - DEVELOPER INFORMATION
Contact person or firm conducting the proposed work
Street Number
Street Name
City
State
Zip Code
Contact Phone
Email
SECTION 6 - DRAINLAYER / EXCAVATOR INFORMATION
*
Name of person or firm excavating the site
Select
*
Street Number
*
Street Name
*
City
*
State
*
Zip Code
*
Contact Phone
*
Email
Dig Safe
SECTION 7 - OTHER DETAILS
*
Description of proposed work – attach applicable plans
DECLARATION
To accept and abide by all provisions of the Town of Milton General Bylaws and of all other pertinent bylaws or regulations that may be adopted by the Town of Milton.
To maintain the sewer to the street at no expense to the Town of Milton.
To pay all appropriate fees, inspection fees and betterment fees prior to the issuance of the water permit.
To notify the Department of Public Works when the sewer service is ready for inspection.
*
I do hereby certify under the pains & penalties of perjury that the information provided above is true and correct.
Date
Select date
* Indicates Mandatory Field.
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