New Connection Application Lewisburg Area Joint Sewer Authority Application for connection To: Lewisburg Area Joint Sewer AuthorityLewisburg, Pennsylvania Date 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:The building (has/will have) storiesand roomsIt (is/will be) used as a There (are/will be) people living or working in the buildingThe building is located at (Borough of Lewisburg) (East Buffalo Township)The Property is boundedon the North byOn the East byOn the South byOn the West by Add RemoveThe source of water is Name of general contractor Name of contractor who will be responsible for sewer installation. (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 propertyOwner Owner -(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 signaturePrint Name Date MM slash DD slash YYYY Sign here(Seal)-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.Print Name Title Business or Partnership Name Date MM slash DD slash YYYY Sign here(Seal)-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.Precise Corporate Name BY Date MM slash DD slash YYYY ATTEST:Secretary or Assistant Sec.CAPTCHA