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   TOWN OF MILTON
   WATER & WASTEWATER DIVISION
   PHONE - 802-893-6030
   EMAIL - telwood@miltonvt.gov

7. WATER & WASTEWATER CONNECTION APPLICATION

9. Applicant Contact Information

11. Name(s)*
12. Email Address*
14. Mailing Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
21. Fax Number
23. Is the owner the same as the applicant?*
    -- Select One --YesNo
25. Owner Name
26. Email Address
28. Address
30. City
31. State
32. Zip Code
34. Phone Number

38. Engineer/Consultant Contact Information

40. Engineer/Consultant Name(s)*
42. Engineer/Consultant Address*
44. Engineer/Constant Phone*
45. Email*

49. Project Information

51. Project Location*
52. Parcel Number
54. What type of project is this?*

    1. Residential
    2. Commercial
    3. Mixed Use
    4. New Development
55. What type(s) of service are you connection to?*
    -- Select One --Water OnlyWastewater OnlyWater & Wastewater
57. Project Description*

    Please provide a brief overview of the project.

59. Approved Water Allocation Amount

    (Gallons per Day)

60. Approved Wastewater Allocate Amount

    (Gallons per Day)

62. Approved State Water & Wastewater Permit Number(s)*

64. Please provide the following information for your project:

66. Residential
68. Water & Wastewater Connections

    Number of Bedrooms

69. Water connection only

    Number of bedrooms

70. Wastewater connection only

    Number of bedrooms

71. Number of proposed meters
73. Commercial
75. Water & Wastewater Connections

    Design flow gallons per day

76. Water connection only

    Design flow gallons per day

77. Wastewater connection only

    Design flow gallons per day

78. Number of proposed meters
80. Public Infrastructure
82. Number of Fire Hydrants
83. Fire Service Connection
84. Infiltration only

    Design flow gallons per day

86. Will this project require a tap into a Champlain Water District line?*
    -- Select One --YesNo
88. Will this property be owner occupied?*
    -- Select One --YesNo
90. Will this property be rented or leased?*
    -- Select One --YesNo
92. Will the connection require work in the Town right-of-way?*
    -- Select One --YesNo
94. Have you applied for a municipal Highway Access Permit?*
    -- Select One --YesNo
96. Upload Highway Access Permit Application Here

    Link to Application

100. Other items to be submitted with this application:

102. 1. Approved State Water & Wastewater Permit*
104. 2. Site Plan/Connection Details*

     Please attach a site plan for the proposed project, to include connection details.

106. 3. Completed & signed applicable fee schedule

     Must be completed and signed by Engineer/Consultant

108. Residential Fee Schedule

     Fillable fee schedule can be found HERE.

     (Please note, forms not complete on Google Chrome may not auto populate correctly)

109. Commercial and/or Mixed Use Fee Schedule

     Fillable fee schedule can be found HERE.

     (Please note, forms not complete on Google Chrome may not auto populate correctly)

110. New Development Fee Schedule

     Fillable fee schedule can be found HERE.

     (Please note, forms not complete on Google Chrome may not auto populate correctly)

112. 4. Application Fee
114. Application payments may be submitted in on of the following ways:

     Online Payment (Please not there is a 3% service fee charged for any debit/credit card transactions) 

     Pay Online Here

     Mail a check to the Municipal Office at 43 Bombardier Road, Milton, VT 05468 (All checks made out to "Town of Milton").

     Pay in person with cash, check or card at the Municipal Office.

115. Which method of payment do you intend to use? *
     -- Select One --Online PaymentMailed CheckIn Person Payment

     Please note that your application will not be deemed complete until both application, and application fee in the correct amount have been successfully collected 

119. Applicant Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
121. Electronic Signature*
Leave This Blank:


132. 1. Receive an email copy of this form.
133. Email address

     This field is not part of the form submission.

134. Submit Submit and Print

* indicates a required field