2. 
4. Commercial/Industrial Application for Water Permit (including multi-family)
6. Service Address*
8. Lot Number
9. Development
11. Owner's Name*
13. Owner's Mailing Address*
15. Owner's Phone #*
17. Builder's Name
19. Builder's Mailing Address
21. Builder's Phone #
23. Plumber's Name
25. Plumber's Mailing Address
27. Plumber's Phone #
29. Municipality*

    1. Ephrata Borough
    2. Clay Township
    3. Ephrata Township
30. Render bills to (during construction)*

    1. Owner
    2. Builder
31. Is a new connection to the main required?

    1. Yes
    2. No
33. Will the wall of the structure be located 100 ft. or more from the street line?

    1. Yes
    2. No
34. How many units will be served*
36. Requested water service size (inches)*
37. Requested water meter size (inches)*
    If requested size is over 3/4", please provide average daily flow in Gallons/minute in the field above.
39. If Fire Service is required, fire service size (inches)
40. If Fire Service is required, fire meter size (inches)
44. I hereby make application for a service connection to the water distribution system of the Ephrata Area Joint Authority. The connection is requested to provide service to the property described above. I fully understand and agree to adhere to all terms and conditions of the Ephrata Area Joint Authority's current Rules and Regulations.
46. Notes: 1) Please allow 5-7 business days for permits to be processed and issued. 2) All water fees are due when the permit is picked up. 3) A copy of the permit will be provided when fees are paid.
48. Owner/Builder Name*
    By entering your name and date above, you are signing this form and agreeing to all the terms and conditions of this application.
49. Date*
    Date
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field