Form Center

2. Building Permit Number*
3. Date*
   Date
5. Contractor*
6. Phone Number*
8. Address*
10. Business Name*
11. Type of Business*
13. Address of Building Site*
17. COMMERCIAL-RESIDENTIAL WATER
19. Meters:
21. New*
22. Existing*
24. Number of Meters Needed:
26. Domestic
27. Size
29. Landscape
30. Size
32. COMMERCIAL-RESIDENTIAL SEWER
34. Building Sq. Ft. *
36. Maximum Number of Employees/Occupancy in Building*
38. Water History (1 Year of History as Like Size Business)*
    Domestic History Only
40. Estimated Gallons Per Day Usage*
42. Fire Line Size
44. CCMA treats the wastewater and will make the final decision on LUE's
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
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field