Water Lateral Repair Application

Please use this application for repairing or replacing a water lateral.

Permit Applicant is:*

Property OwnerContractor (Authorized by Owner)Tenant (Authorized by Owner)

Name (property owner where work will be performed)*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant's Phone#*

Area CodePhone Number

Applicant's email*

Contractor's Name (Write SELF if the property owner is constructing improvements)*

Contractor's Address (Leave blank if you listed SELF above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contractor's Phone #

Area CodePhone Number

Contractor's email*

Contractor's PaHIC #

Describe the work to be performed:

Is this an Emergency Repair?*

YesNo

Approx. Length of Lateral Repair: *

In feet

Diameter of Lateral *

In inches

Approximate Depth of Lateral *

In Feet

New Lateral Material*

Yard lateral will be installed in:*

RearSideFront

Will sidewalk need to be removed?*

YesNo

Will street need to be cut or excavated?*

YesNo

I hereby certify the code administrator and code inspectors shall have the authority to enter areas covered by such permit application at any reasonable hour to inspect existing conditions applicable to such permit application*

I agreeI disagree

Attach any files you may have

Upload a File

Drawings are appreciated. Not required. You may also email additional drawings to sloomis@amitytownshippa.com

I, the applicant, hereby agree to electronically sign my permit and agree to install the improvements only in accordance with the permit and will conform to the requirements of the existing Ordinances of the Township of Amity and Laws of the Commonwealth of Pennsylvania. I understand there are required inspections listed on the back of the permit that I must get approved prior to occupying the improvement. The permit will not relieve me from complying with other governmental regulations, deed restrictions or covenants outside the jurisdiction of Amity Township.*

I agree, and I choose to receive my permit by first class mailI do not wish to sign electronically, and I will make arrangements for either myself or someone I have authorized to come in to the Code Department M-F, between 8 am-noon or 1:00-4:30 pm to sign and pay for the permit

All contractors and installers performing residential improvements must provide a certificate of insurance naming Amity Township as a Certificate Holder. All contractors performing improvements on commercial buildings or new home construction must obtain an Amity Township Contractor's License. Applications are available on this website.

Once the application is received, permit processing typically takes 7-10 business days. Please check your email during this process as we may contact you for additional information that may be required or that your permit is ready for final processing. Permit fees will be due upon issuance of the permit. Permit fees can be found on the Building Department web page.

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OFFICE USE ONLY

ENTERED ____________ COI REQ ____________ NOTIFIED __________ SCANNED ____________