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2. Sewer Waiver Request Form
4. Request Date:
   Request Date:
6. Physical Address:
7. Property Location PIN #
9. Please upload a digital map of the property with your request:
11. Requestor First Name:
12. Requestor Last Name:
14. Requestor Company Name:
16. Contact Phone Number:
17. Contact Email Address:
19. Cost To The Developer To Connect To County Sewer
21. Distance to Gravity Sewer
22. Distance to Force Main
24. Details:
26. Comments:

28. The Utilities Department will schedule an appointment for you to meet with the Utilities Committee. You will be notified in writing the results of your waiver request.

    For additional information please contact Utilities Director, James McQueen jmcqueen@hokecounty.org or Laura Sterling lsterling@hokecounty.org

    
    

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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

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