WEST MIFFLIN SANITARY SEWER MUNICIPAL AUTHORITY

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 of the West Mifflin Sanitary Sewer Municipal Authority the total Tap-in Fee is $2,868.00 per EDU (effluent discharge unit). $2,868.00 X # of EDU’s = $ total to be paid with application.

(PAYMENT BY CHECK OR MONEY ORDER ONLY).

PROPERTY LOCATION



                                                                                                           Street Address



                                                                                                            Lot & Block #

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 -1 EDU = 226 gallons per day (For three or more EDU’s an approved Planning Module must be submitted with the application.)

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

___________________________________________

Signature