WEST MIFFLIN SANITARY SEWER MUNICIPAL AUTHORITY

www.wmssma.org

1302 Lower Bull Run Road West Mifflin, PA 15122-2902

Phone: (412) 466-6070 Fax: (412) 466-8108

SEWER TAP-IN PERMIT APPLICATION

For Customers EXEMPT from Tap-in-Fees (Sewer extension projects funded by certain types of state or federal grants)

PROPERTY LOCATION

Street Address

Lot & Block #

Municipality

PROPERTY OWNER

                                                               __________                                                 Name & phone

                                               __                                                   Street Address

 __        City, State, Zip

CONTRACTOR

                                             __________                                                                   Name & phone

                                             __________                                                                   Street address

                                             __________                                                                   City, State, Zip

Type of Building Construction     _ Single Family Residence

Multi Family Residence

Commercial

Industrial

Number of EDU’s (effluent discharge unit) _ (For three or more EDU’s an approved Planning Module must be submitted with the application.)

 (1 EDU = 226 gallons per day).

Is a sewer extension necessary to serve this development? Yes/No

If yes, then two sets of design drawings prepared by a registered professional engineer or surveyor must be submitted with this application. If no, then submit a sketch of how the private lateral will connect to the public sewer.

Does the public sewer abut your property? Yes/No

I certify that the information provided above is true and correct to the best of my knowledge.

Signature of Applicant

___________________________________________