(I/We) hereby make application for permit to make necessary acceptable repairs
to the sewer lateral connected to LEWISBURG AREA JOINT SEWER AUTHORITY sewer.
The following facts are given as a basis for the permit:
If signer is an individual
use this signature block.
Print name exactly as it
appears in the signature
and enter the date of
signature.
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.
If signer is a Corporation,
use this signature block.
Fill in corporate name,
sign, attest, date and affix
the corporate seal.