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7. Water and/or Wastewater Allocation Approval Application
9. Application Fee: $25.00 Water / $25.00 Wastewater
11. Applicant Information
13. Name (First & Last)*
14. Email Address*

    Please enter "none" if you do not have an active email address.

16. Address*
18. City*
19. State*
20. Zip Code*
22. Phone Number*
23. Fax Number
25. Which method of communication do you prefer?*
    -- Select One --EmailPhoneMail
27. Owner Information

    If different than applicant

29. Name
30. Email Address
32. Address
34. City
35. State
36. Zip Code
38. Phone Number
39. Fax Number
41. Consultant/Engineer Information
43. Name*
44. Email Address*
46. Address*
48. City*
49. State*
50. Zip Code*
52. Phone Number*
53. Fax Number
57. Project Information

    It is recommended all applicants meet with DPW staff prior to submitting an allocation application.  Staff will be able to discuss the site location, and provide local record drawings, when available.  All projects must be designed to Town of Milton DPW Specifications.  Links to helpful resource, i.e., local ordinances and State rules, are available on the DPW Website at http://miltonvt.gov/464/Helpful-Resources

    Construction of public infrastructure requires following the public infrastructure acceptance process. For further information see Section 110 of the Milton DPW Specifications, located at Public-Works-Specifications-PDF (miltonvt.gov).

59. Project Location*
60. Tax Map / Parcel ID Number
62. Type of Project*
    -- Select One --ResidentialCommercialMixed Use
64. Project Description*
66. For Single Family Residences Only, how many bedrooms will the structure have? *

    If not applicable, please enter "N/A"

68. Water Allocation Request (Gallons per Day)*

    If not applicable, please enter "0"

69. Wastewater Allocation Request (Gallons per Day)*

    If not applicable, please enter "0"

71. As required by the Water & Wastewater Ordinances, a copy of the Registered Professional Engineer’s (RPE’s) calculations for the water/wastewater volume, including peak, maximum and average day flow rate, wastewater strength and any other characteristics determined to be appropriate by the Water & Wastewater Department is to be submitted with this application.
72. Upload RPE Calculations Here*

    Must be signed by consulting engineer to be deemed complete.

76. Please provide the following information about your project:
78. 1. Preliminary site plan and proposed connection detail*
80. 2. Is the request for a connection within a current service area? *
    -- Select One --YesNo
82. 3. Is there an existing building on the lot?*
    -- Select One --YesNo
83. 3a. If yes to No. 3, will it be used for the project?*
    -- Select One --YesNoNot Applicable
85. If yes to No. 3, is the building already connected to municipal water or wastewater?*
    -- Select One --YesNoNot Applicable
87. 4. Is there a water supply or septic system failure?*
    -- Select One --YesNo
88. 4a. If yes to No. 4, please provide an engineer or site technicians' statement
92. If the proposed project is not within a current service area as indicated in the Water and Wastewater Ordinances, please answer the following:
94. 5. Approximately how close is the nearest service area to the project location?
    • Milton Water Service Area Map
    • Milton Wastewater Service Area Map
96. If this request is for a project/building not yet existing, please answer the following:
98. 6. Is DRB approval necessary? *
    -- Select One --YesNoNot Applicable
99. 6a. If yes to No. 6, have you applied for DRB approval?*
    -- Select One --YesNoNot Applicable
101. 6b. If yes to No. 6a, do you have approval from the DRB?*
     -- Select One --YesNoNot Applicable
102. 6c. If yes to No. 6b, what is the DRB case number?
106. I/We certify that the calculations and information above is correct to the best of my/our knowledge:
107. *Applicant Name:
109. 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.
111. Electronic Signature*
113. Application payments may be submitted in one 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.
114. 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 few in the correct amount have been successfully collected

116. *NOTE; If applicant is different than owner, further confirmation and/or signatures may be required by the property owner at a later date.
Leave This Blank:


126. 1. Receive an email copy of this form.
127. Email address

     This field is not part of the form submission.

128. Submit Submit and Print

* indicates a required field