(Please print or type)
The undersigned hereby applies for a Sewer Transmission/Water Distribution Line Agreement with the Town of Shallotte. The Sewer Transmission/Water Distribution Line Reimbursement is for the construction of an approved sewer transmission and/or water distribution line to serve the subject project. The transmission/distribution line(s) must be designated on the Master Wastewater Plan or approved by the Public Works Director during plan approval. The following information is required prior to processing the application and drafting an Agreement to be presented to the Board of Aldermen.
Size of transmission/distribution line(s) installed: __________________________________________________
Total acreage to be developed: _________________________________________________________________
Size of utility required to serve project: ____________________________________________________________
Total number of residential equivalent units included in project: ________________________________________
Project Name: ______________________________________________________________________________
Location: __________________________________________________________________________________
Date of Town Approval of Project: _____________________________________________________________
Developer/Owner:___________________________________________________________________________
(Name of Person designated to receive reimbursement payment)
Company Name, Address*: ____________________________________________________________________
City, State, Zip: _____________________________________________________________________________
Phone Number: ( ) _________________________ Fax Number ( ) _______________________________
Project Consultant/Engineer: ___________________________________________________________________
Contact Person Phone Number: ( ) ____________________________________________________________
* Note: This address will be used for all correspondence and payments It is the responsibility of the owner to notify the Town of Shallotte of any changes.
(Ord. 07-38, passed 11-6-2007)