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Version 6/11/2024 <br /> <br />Length of lateral: <br /> <br />Depth of lateral: <br /> <br />Building permit #: <br /> <br />Right of way excavation and occupancy permit applied? Yes No <br /> <br /> <br />I do hereby certify and affirm that all the information given in this application is true to <br />the best of my knowledge. I understand and agree that work on the sewer lateral cannot <br />commence till I have received pre-approval from the city to participate in the program. <br />By signing this application, I am guaranteeing that the sale price of the home will be at or <br />below the threshold stated in the program guidelines and agreeing that if the house sells <br />for higher than this threshold, I will reimburse the City the entire reimbursement amount <br />granted as part of this program. <br /> <br /> <br /> <br />SIGNATURE Date <br /> <br />PRINT NAME <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />OFFICE USE ONLY: <br /> <br />Date Received: Pre-Approval Date: <br /> <br />Pre-Approval Amount: <br /> <br />Reviewed by: <br /> <br />Notes: