Sewer Permit Application

"*" indicates required fields

Instructions:

No work may begin until the Wastewater Department has issued a permit.
ALL sections of the application must be filled out in its entirety or it will be returned as incomplete. /li>
If the Applicant is not the property owner, the property owner's signature is required.
Each application must be accompanied by a plan accurately locating the proposed location of the service lateral (building sewer) and connection or the area of repair.
No permit will be issued until the appropriate fee(s) have been paid.

The Borough of Highspire is seeking your feedback to develop a comprehensive and inclusive plan to improve our community. We thank you for your participation!

Property Information

Applicant Name*

Phone Number*

Cell Phone Number*

Email Address*

Property Location (Address)*

Street Address City State ZIP Code

Is the Property Owner different from the Applicant?*

Yes

Name of Property Owner*

Property Owner Phone Number*

Property Owner Cell Phone Number*

Address of Property Owner*

Street Address City State ZIP Code

Property Owner Email Address*

Name of Contractor or Person Performing work*

Phone Number*

FAX Number*

Address of Contractor or Person Performing Work*

Street Address City State ZIP Code

Type of Building*

# of Units*

Work to be Done*

Pipe Size*

Type of Pipe*

Length of Service Lateral*

Cleanouts?*

Yes

# of Cleanouts*

Note: Prohibited connections include sump pumps, downspouts, area drains, french drains, footer drains or any other connection that would allow storm or ground water to enter the sanitary sewer system.

Fees

Mail Checks to: 640 Eshelman Street, Highspire, PA 17034

EDU Connection Fee*

I confirm that I am responsible for submitting a check for an E.D.U Connection Fee of $1,500.

Paid By*

Date*

Check #*

Inspection Fee*

I confirm that I am responsible for submitting a check for an Inspection Fee of $150.

Paid By*

Date*

Check #*

Signature Agreement

As applicant for a permit; the undersigned agrees to abide by all provisions of Highspire Borough Sewer Ordinance No. 595 and all other rules, regulations and specifications governing construction of, connection to, and use of the service lateral serving my property, and certify all work under this permit was performed either by myself or my contractor/plumber.

Applicant Signature*

Date*

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Name

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Sewer Permit Application

Property Information

Fees

Signature Agreement

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