Form Center

2. I hereby submit this request for connection to the Town of Colonial Beach’s water/sewer systems.
4. Name
6. The location of the property is:
8. Street(s)
10. Tax Map Number
12. Subdivision
14. Property Owner’s Name
16. E-mail
17. Telephone Number
19. Department of Planning & Community Development
21. Permit Number
23. Availability - To be completed by Director of Public Works

    1. Yes, water and sewer are available for connection at this location.
    2. No, water and sewer are NOT currently available for connection at this location. Connections cannot be completed until an engineered plan is submitted, approved, bonded, and installed.
25. Signature of Public Works Director
26. Date
    Date
28. • Upon Completion Forward to: Finance Department
30. To be completed by Director of Finance
    To be completed by Director of Finance

    Payment received on

31. Amount

    in the amount of $

33. Signature of Finance Director
34. Date
    Date
36. • Upon Completion Forward to: Town Manager
38. To be completed by Director of Public Works
    To be completed by Director of Public Works

    Connection completed on

40. Signature of Public Works Director
41. Date
    Date
43. • Upon Completion Forward to: Finance Department
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field