City of LaFayette

LaFayette, Georgia

Sewer service application

Date of application:  Day _____     Month:  _____     Year:  _____

Name:  ___________________________________     Phone:_____________

Address:  ______________________________________________________

______________________________________________________________

Describe in detail the location where service is needed.  ____________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Type of service:              Residential  _____                                      Commercial  _____

                                      Industrial  _____                                        Other  _____

This is only an application for sewer service and can only be approved after investigation by sewerage department personnel.

____________________________

Applicant’s signature

_________________________________________________________________________

Do not write below this line

_____  Sewer is available but may have to be pumped by the owner.

_____  Sewer is not available.

_____  Sewer is already on the property and owner should connect to existing service.

Comments:  _______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

____________________________                          ____________________________       

Checked by                      Date                                   Director of sewerage                    Date

Return to Administration.