New Connection Application

Lewisburg Area Joint Sewer Authority

Application for connection

To: Lewisburg Area Joint Sewer Authority

Lewisburg, Pennsylvania

MM slash DD slash YYYY
(I/We) hereby make application for permit to connect with the LEWISBURG AREA JOINT SEWER AUTHORITY sewer. The following facts are given as a basis for the permit:
stories
rooms
people living or working in the building
(Borough of Lewisburg) (East Buffalo Township)
The Property is bounded
on the North by
On the East by
On the South by
On the West by
 
(I/We) have read the Rules and Regulations of the LEWISBURG AREA JOINT SEWER AUTHORITY and agree to be bound by them, and warrant that (I am/ We are) the legal owner(s) of the above described property

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(I/We) have read the Rules and Regulations of the LEWISBURG AREA JOINT SEWER AUTHORITY and as contractor or sub-contractor on the building to which this permit refers, (I/We) agree to be bound by them.
If signer is an individual use this signature block. Print name exactly as it appears in the signature and enter the date of signature
MM slash DD slash YYYY
(Seal)

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If signer is an individual trading under a fictitious name or represents a partnership, use this signature block. Print name exactly as it appears in the signature, give the business title of the signer, print the precise business name, and enter the date.
MM slash DD slash YYYY
(Seal)

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If signer is an individual trading under a fictitious name or represents a partnership, use this signature block. Print name exactly as it appears in the signature, give the business title of the signer, print the precise business name, and enter the date.
MM slash DD slash YYYY
Secretary or Assistant Sec.

Lewisburg Sewer

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