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2. Date:*
   Date:
3. Applicant is:*

   1. Owner
   2. Contractor
   3. Architect/Engineer
   4. Other
5. Last Name*
6. First Name*
8. Applicant Mailing Address:
10. Applicant City:
11. Applicant State:
12. Applicant Zip:
14. Email:*
15. Phone:
17. Subject APN and/or Address

    Enter all the Assessor Parcel Numbers (APN) and/or Addresses for Properties Needing a Water /Sewer Availability Letter.

19. Notes:
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field