Water Main Application

NOTE: If your project includes an off-site main, two separate applications will be required. Please indicate there will be an off-site component in the Project Description below.

General Information

Utility

Project Name

Project Description

Primary Contact Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email

Primary Contact Phone Number

Requested Project Location

Permit Address

State

Township

City

Postal Code

Subdivision (if applicable)

Section (if applicable)

Owner/Developer Information

Company Name

Address

City

State

Postal Code

Contact Person First Name

Contact Person Last Name

Phone

Email

Design Firm Information

Company Name

Address

City

State

Postal Code

Contact Person First Name

Contact Person Last Name

Phone

Email

Contractor Information

Contractor Name

Phone

Email

Citizens Bond #

Address

City

State

Postal Code

Water Design Summary

The new water main intends to connect to an existing

-inch diameter water main

(relative to streets)

Domestic Demands

GPM = Gallons Per Minute

Usage Type	No of Connections	Demand per Connection (GPM)	Subtotal (GPM)
Single Family			0
Multi-Family			0
Commercial			0
Industrial			0
Total Domestic Demand:			0

Water Main and Hydrants

Size,in	Length,ft	Material




Total Length	0 ft.
Total No. Hydrants

Upload Supporting Documentation

Allowed File Types: doc,docx,xls,xlsx,dwg,pdf,jpg,jpeg,tiff,tif,png
Combined File Size Limit: 15MB

Terms and Conditions

Water Main Application Terms and Conditions

I agree to the Terms and Conditions and I have been authorized by the property owner to perform the work described in this application