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2. Application Year*
3. Please Select an option

   1. New Application
   2. Renewal
5. Installation Fees*
   -- Select One --Water Line Installation - Fee $100Sewer Line Installation - Fee $100Both Water and Sewer Line Installation - Fee $200

   Before Application can be approved, fee needs to be submitted to the Water/Sewer Department. Drop box is located at 90 Cottage Street.
7. Business Name*
9. Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
19. Email Address*
21. Please describe you experience in Water/Sewer work excavating for house connections
25. File Upload
    Please upload 3 reference letters
27. Please list (3) references from other Cities/Towns
29. Recommendation 1)
31. Recommendation 2)
33. Recommendation 3)
35. Has Your License to install Water/Sewer lines ever been revoked?*

    1. Yes

    1. No
37. ENCLOSE A YEARLY UPDATED LICENSE CERTIFICATION FORM, INCLUDING XCU (if applicable) $300,000-$1,000,000 TO BE ON FILE BEFORE APPROVAL. Upload below
39. Upload Certificates
41. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
43. Electronic Signature
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field