Connection Application Form

Instructions:

  • Once the application is started, it needs to be completed  and submitted or the data entered will be lost.
  • Application must be signed in the signature field at the bottom of this form by entering your full name.
  • Please refer to http://www.eaglecounty.us/Assessor/ for Legal Description of Property information.
  • Complete Applications may take up to two weeks for processing from the date of submittal.

Application Type

(Please Check All That Apply)

Service Line: WaterSewer
Mainline Extension: WaterSewer
Easement Review: NewModificationVacation
Easement Encroachment
Plan Review: ConceptualDraft DesignFinal Design
Variance Request? Yes

Section of the Rules & Regulations Variance Request is in reference to:
Please describe the Variance Request:
Other Review? Yes

Please describe:

Legal Description of Property

Parcel Number:
Subdivision:
Lot Acres:
Lot:
Block:
Filing:
Tract:
Section:
Township:
Range:

Physical Address:
City:
Tax Area Code:

Project Information

(Please Check All That Apply)

Project Name:
Account Number: (If Available)
Residential? Yes
Type of Residential: Single FamilyDuplexMulti-Family
# of Dwelling Units:
# of Lots:
Approx Sqft:
Commercial? Yes
Approx SqFt:
Description (include approx fixture count):
Mixed Use? Yes
Commercial Mixed Use
Approx SqFt:
Description (include approx fixture count):
Residential Mixed Use
Approx Sqft:

# of Dwelling Units:
# of Lots:
Description:
Irrigation Use? Yes
Approx SqFt:
Description:

Will the Project require a Zone Change with the Land Use Authority? YesNo
Does this project exist in a approved Planned Unit Development (PUD)? YesNo
Detailed Description of Project:

Applicant Information

Property Owner Name:
Mailing Address:
Apt/Suite:
City:
State:
Zip:
Phone #:
Cell #:
Fax #:
Email Address:

Applicant Representative Information

Company Name:
Applicant Representative Name:
Mailing Address:
Apt/Suite:
City:
State:
Zip:
Phone #:
Cell #:
Fax #:
Email Address:

Upload Files

(You can upload up to 4 files. Max file size 3mb/file.)

By entering my full name in the field below as either 'Signature Applicant' or 'Signature Applicant Rep' and submitting this form, I do hereby certify that the foregoing representations and attachments are true and correct to the best of my knowledge. I acknowledge I am aware of the Eagle River Water & Sanitation District Rules & Regulations found at www.erwsd.org.

Signature