2. 
4. Residential Application for Sewer Permit (single family dwelling)
6. Service Address*
8. Lot Number
9. Development
11. Owner's Name*
13. Owner's Mailing Address*
15. Owner's Phone #*
17. Builder's Name
19. Builder's Mailing Address
21. Builder's Phone #
23. Plumber's Name
25. Plumber's Mailing Address
27. Plumber's Phone #
29. Municipality*

    1. Ephrata Borough
    2. Clay Township
    3. Ephrata Township
30. Render bills to (during construction)*

    1. Owner
    2. Builder
31. Is a new connection to the main required?*

    1. Yes
    2. No
35. I hereby make application for a service connection to the sewage collection system of the Borough of Ephrata for the property described above. I fully understand and agree to adhere to all terms and conditions of the Code of the Borough as they relate to the sanitary sewer system.
37. Owner/Builder Name*
    By entering your name and date above, you are signing this form and agreeing to all the terms and conditions of this application.
38. Date*
    Date
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field