Water and Sewer Connection Request Form -The City of Vancouver, WA

Applicant Name(Required)

First Last

Check this box is applicant is not the property owner

Not property owner

Property owner name

First Last

Property owner email

Property owner phone

Applicant Phone Number(Required)

Applicant Email(Required)

Occupancy Type(Required)

Type of Permit(Required)

Water Meter

Sewer Connection

Choose all that apply

Please indicate if any of the following special plumbing or activities apply to this project address

Choose all that apply

Please indicate if this site/premises includes any of the following

Choose all that apply

Water Meter Size

Type of Service

Meter Install

Meter Relocation (less than 10 feet)

Meter Relocation (more than 10 feet)

Water Service Installation (City to install line from water main to property line)

Water Full Service Installation (City to install line from water main to property line, includes meter install)

Deduct Meter

Meter Box Replacement or Raise Yoke

1″ Yoke Replacement (specify service size in additional information field below)

Choose all that apply

Project

Subdivision Name(Required)

Please enter the subdivision name here. If lot is not in a subdivision, please enter “N/A”. Please also include Phase # if applicable.

Lot Number(Required)

Please enter the number for the lot you are requesting. If requesting multiple lots within the same subdivision please enter each lot number separated by a coma (e.g. 4, 11, 20) If no lot number, please enter “N/A”.

Project Address(Required)

Please enter address where you are requesting permit(s). If requesting multiple addresses please list each address separated by a coma (e.g. 123 Main St, 456 Main St, 789 Main St)

Associated Building Permit(Required)

Enter associated building permit number(s), (e.g. RES-158799) If no associated building permit, please enter “NA”.

Pick-Up Date

Please enter the date you plan to pick up requested permit(s)

Additional Information

Please enter any additional information unique to your request. Include details regarding use type and/or type of business if applicable.

ePermits User Name

If you have an existing ePermits User Name that allows you to pay online please provide it so we can associate it to your application.

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