2. 
4. Residential Application for Water Permit (single family dwelling)
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. If Fire Service is required, fire service size
34. If Fire Service is required, fire meter size
38. Twenty-one calendar days after payment is received the Ephrata Borough’s Public Works Department will automatically install the water meter in an authority approved water meter pit. If at the time of installation the water meter pit does not comply with the Ephrata Area Joint Authority Rules & Regulations, no meter will be installed and the applicant will be invoiced for a special service fee for a failed installation. Attempts to install the water meter will automatically occur at one week intervals until the meter can be installed and every unsuccessful attempt will be invoiced a special service fee. If a meter is desired prior to the 21 days please contact the Public Works Department at 717-738-9242 to schedule an appointment.
40. 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.
42. 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.
44. 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.
45. Date*
    Date
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field