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2. TAPS BEING REQUESTED:

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

   1. Demo
   2. Rebuild
   3. New Build
   4. Other
10. If other, please explain.
12. DO YOU HAVE EXISTING SERVICES AT THIS LOCATION?

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

    1. Water
    2. Gas
    3. Sewer
16. First Name
17. Last Name
19. Phone Number
20. Email Address
22. REQUESTED SERVICE LOCATION
24. 911 Address
26. City
27. State
28. Zip Code
30. Map
31. GP
32. Parcel
34. Lot #
36. City Limits

    1. Inside City Limits
    2. Outside City Limits
38. MAILING ADDRESS
40. Address
42. City
43. State
44. Zip Code
46. 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.
48. Electronic Signature
50. ***PLEASE NOTE THIS IS A TAP REQUEST. YOU WILL BE NOTIFIED WITHIN 30 BUSINESS DAYS OF THE TAP REQUEST DECISION. ***THANK YOU
52. Know what’s below. Call 811 before you dig.
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field