SOUT HWEST H A R BOR WATER & SEWER
PERMIT APPLICATION
(for new service, or change of use)

Owner’s Name  	

Tele/Cell  	

Address	Town				State	Zip  	  Email Address				Contractor  			  Contractor Address		Town		State	Zip  	  Contractor Tele/Cell			Email Address  			

SITE DESCRIPTION:
Address  	

Map  	

Lot	_

Existing Use		,  Existing Number of Bedrooms 		  Proposed Use		,  Proposed Increase of Bedrooms 	  Number of Dwelling Units		Commercial:                                      Type of facility  				 EXISTING  OWNERS LINES:	WATER, Type Material		, Size  		
SEWER, Type Material	, Size  	 PROPOSED  OWNERS LINES:   For Class II uses, provide drawings, specifications, etc.

Date:  	

Applicant(s) Signature _ 	

Note: An interior plumbing permit must be obtained from the Local Plumbing Inspector prior to providing sewer or water service. Prior to start of construction, Dig Safe authorization number (1-888-344-7233) must be provided to the Public Works Director. The owner/applicant is responsible for costs of equipment, labor, and material to provide water, by the Department, from the main line to the Owners property line. For sewer service, the owner is responsible for contracting the installation of the service line under the supervision of the Sewer Department. No road opening between November 1 and April 1 without express authorization from the Town of Southwest Harbor.

CONDITIONS:  	

Date: Date: Date:

District Manager Wastewater Superintendent Public Works Director

FEES	
Sewer:   Application
Service 
Total Sewer Fee:	
$	75.00
$1,000.00  
	
	Water:   Application
Service	$10.00
$50.00/$105.00(service after hours)	

$  	

Total Water Fee:	$