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Sewer & Water Hook-up/Repair (Residential Only)

  1. Office Use Only
    Date: ________________ Permit #: _______________ PID #: ___________________ Notes: _______ Total $: ______________
  2. Sewer & Water Hook-Up/Repair (Residential only)
    Permit will not be final until ASBUILT form is completed and received.
  3. Property Type*
  4. Construction Type*
  5. The Applicant is*
  6. If applicant is other, please explain
  7. Property Owner Contact Information
  8. Contractor Contact Information
  9. Type of work:
    Select the applicable types of work below and indicate the materials used.
  10. Provide a detailed description of the work that will be done for this project.
  11. Will work be done in the public right-of-way?*
  12. Will construction disrupt the street/sidewalk surface?*
  13. Disclosure*
    The applicant agrees to replace all materials and street surfacing according to the specifications and under the supervision of the Street Superintendent of the City of Elk River. Applicant must also call for appropriate inspections. Note: Unused septic tanks, cesspools, leaching pits, and similar devices shall be backfilled or made safe and unusable in a manner acceptable to the city.
  14. Payment*
    Permits must be paid for before being issued.
  15. Receipt of Permit*
  16. Indicate who to contact for payment.
  17. This is an application for a permit - it is not valid until processed*
    I hereby apply for a Sewer & Water Hook-up/Repair permit, and I acknowledge that the information above is complete and accurate; that I understand this is not a permit and work is not to start without a permit. I understand and hereby agree that the work for which the permit issued shall be performed according to; (1) the conditions of the permit; (2) the approved plans and specifications; (3) the applicable city approvals, ordinances, and codes; and, (4) the state building/mechanical codes and regulations. I understand that the permit will expire, and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time after work has commenced; and, that I am responsible for ensuring that all required inspections are requested in conformance with the state building code.
  18. 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.
  19. Leave This Blank:

  20. This field is not part of the form submission.