Single-Service Residential Availability Form

2. TAPS BEING REQUESTED:*

   1. Water
   2. Gas
   3. Sewer
4. WHAT WILL TAP BE USED FOR (HOUSE, GARDEN, SHOP, BARN)? *
6. IS THIS REQUEST FOR A (CHECK ONE):*

   1. Demo
   2. Rebuild
   3. New Build
   4. Other
8. if other, please explain.
10. WHAT IS BEING BUILT?*

    1. Single-Family house
    2. Duplex
    3. Townhome
    4. Other
12. If other, please explain.
14. DO YOU HAVE EXISTING SERVICES AT THIS LOCATION?*

    1. Yes
    2. No
16. IF SO, WHICH SERVICE?

    1. Water
    2. Gas
    3. Sewer
18. First Name*
19. Last Name*
21. Phone Number *
22. Email Address*
24. REQUESTED SERVICE LOCATION
26. 911 Address*
28. City*
29. State*
30. Zip Code*
32. Map
33. GP
34. Parcel
36. Lot #
38. City Limits*

    1. Inside City Limits
    2. Outside City Limits
40. MAILING ADDRESS
42. Address*
44. City*
45. State*
46. Zip Code*
48. Attach Files
50. 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.
52. Electronic Signature*
54. ***PLEASE NOTE THIS IS A TAP REQUEST. YOU WILL BE NOTIFIED WITHIN 30 BUSINESS DAYS OF THE TAP REQUEST DECISION. ***THANK YOU
56. If the City shall be required to hire a third-party contractor to install a service, the applicant will be required to reimburse the City for any cost for a third-party contractor. All fees must be paid before services are cut on. Applications must be submitted with a 911 address before any services are approved. Please submit a plat with request if available or a map of property requested. Confirmation must be in written form when utilities are approved.
58. For Application Updates Please Call 615-323-1437 ext. 621, Know what’s below. Call 811 before you dig.
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field