2. 
4. Residential Lateral New Installation or Replacement Permit Application
6. Address of Improvement*
8. Property Owner's Name*
10. Property Owner's Address*
12. Property Owner's Phone #*
14. Applicant's Name (if other than owner)
16. Applicant's Address (if other than owner)
18. Applicant's Phone # (if other than owner)
20. Type of Improvement (check all that apply)*

    1. Water Lateral Replacement/Installation
    2. Sewer Lateral Replacement/Installation
    3. Natural Gas Lateral Installation
22. Description of Work*
24. Linear Footage of Replacement/Installation
26. Name of Installer
30. The applicant certifies that all information on this application is correct and the work will be completed in accordance with the approved, construction documents and PA Act 45 (Uniform Construction Code) where applicable. The property owner and applicant assumes the responsibility of locating all property lines, setback lines, easements, rights-of way, flood areas, etc. Issuance of a permit and approval of construction documents shall not be construed as authority to violate, cancel or set aside any provisions of the codes or ordinances of the Municipality or any other governing body. The applicant certifies he/she understands all the applicable codes, ordinances and regulations.
32. Application for a permit shall be made by the owner or lessee of the building or structure, or agent of either, or by the registered design professional employed in connection with the proposed work.
34. I certify that the code administrator or the code administrator’s authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the code(s) applicable to such permit.
36. Name*
37. Date*
    Date
39. By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

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