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2. *DEPARTMENT USE ONLY

   PERMIT NO:___________________________

   DATE ISSUED:_________________________

6. APPLICATION DATE:*
   APPLICATION DATE:
8. Site/Tap Address:*
10. Lot #:
11. Subdivision:
12. Flood Plain Zone:*
    -- Select One --YESNO
13. Development permit #:
15. Applicant Name:*
17. Applicant Address:
18. Applicant Address2:
20. City
21. State
22. Zip
24. Applicant Phone No:
25. Applicant Email:
27. Tapper's Name*
28. Registration No:
30. Tapper's Phone No:*
31. Tappor's Email:*

33. Note: All contractors/tappers must be registered with the city.  If more that one contractor please provide a list of contractors including name, address, phone number and work providing

35. Applying for Use of:*
    -- Select One --Single FamilyMulti-Family 2-3*Multi-Family 3+*Commercial*Industrial

    * - Needs additional information

37. No of Multi-Family Units :
38. Square footage:
40. Size of Tap Requested:
41. Size of Meter Requested:
45. Conditions
    • The owner shall comply with all applicable laws of the State of Oho and ordinances, policies, and specifications of the City of Lancaster pertaining to construction, repair, replacement, maintenance, tapping or removal of a sanitary sewer main or lateral connected directly or indirectly to the City of Lancaster sewerage system
    • No clean water connections may be made to the sanitary sewer system.
    • All areas disturbed shall be restored to its original or better condition in accordance with City of Lancaster standards.
    • All taps and service tines must be Inspected. To ensure Inspection date and time, a minimum of 24-hour notice (excluding weekends and holidays) is required, call (7401 687 -6614 to schedule inspection . No backfilling of sewers shall begin until approval from the City Engineer or his designee has been given
    • The City of Lancaster does not guarantee the accuracy of the location of any existing taps installed during sanitary sewer installation. It shall be the owner's responsibility to furnish an acceptable sewer tap from the city sewer to the structure. The city shall not be held liable for any costs incurred in furnishing this tap.
    • This tap shall be subject to any other future change of policy or rule or regulation addition or change in the future.
    • For additional information, please see City of Lancaster Construction and Material Standards.
    • A sewer tap fee, capacity, surcharges and inspection fees must be paid, before a tap shall be installed. This permit covers both the tap and capacity fees for 12 months. After expiration, permit holder is subject to the new fee structure.
    • No tap or service line may be installed until the required Right of Way Permit is issued.
    • The sewer tapper is responsible for notifying all utilities and the Ohio Utilities Protection Service a minimum of forty eight (48) hours before beginning work
    • Work must be completed by a contractor registered with the City of Lancaster Certified Building Department.
47. 48 Hours Before You Dig Call Utilities Protection Service at 811 or 1-800-362-2764

    This permit expires one (1) year from date of issue. Work must begin prior to expiration date. You may renew this permit one time prior to the expiration date at the Certified Building Department at 121 E. Chestnut St, Lancaster OH 43130 

49. Signature: *

    Owner/Applicant signature verifies that you have read and agreed to the conditions attached to this Sewer Tap Application Form.

50. DATE:*
    DATE:
54. *OFFICE USE ONLY
56. TAP ALREADY INSTALLED:
    • YES
    • NO
57. SERVICE AREA:
    • INSIDE CORP LIMIT
    • OUTSIDE CORP LIMIT
58. TAP REQUESTED
    • APPROVED
    • DISAPPROVED
60. TRUNK SEWER SURCHARGE: $_______________
61. INSPECTION FEE: $_________________
62. CREDIT FOR PREVIOUS TAPS: $________________
64. TAP FEE: $_______________
65. CAPACITY FEE: $_______________
66. TOTAL FEES DUE: $______________
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field