Form Center

2. 
3. City of Laconia
   Dept. of Public Works
4. NOTE THAT QUESTIONS FOLLOWED BY AN ASTERISK * REQUIRE AN ANSWER IN ORDER TO SUBMIT YOUR APPLICATION
6. Property Owner Name*
7. Date*
   Date
9. Mailing Address
11. City
12. State
13. Zip Code
15. Phone Number*
16. Email Address*
18. Work Site Street Address*
    (if different than Mailing Address)
22. Contractor Name*
    (the person responsible to connect with the sewer)
23. Company
25. Mailing Address
27. City
28. State
29. Zip Code
31. Phone Number*
32. Email Address*
36. Plumber Name
    (if different than contractor)
38. Phone Number
39. Email Address
43. I wish to connect with the public sewer a
    building type: residence, motel, laundromat, trailer, . . .
45. containing the following fixtures:
    (Type in the number of each type of fixture. If you skip an answer, it is considered zero.)
46. Bath Group
48. Water Closets
49. Lavatories
50. Automatic Washers
52. Bath Tubs
53. Sinks
54. Dish Washers
56. Urinal
57. Showers
58. Garbage Disposal
60. I agree for myself, my heirs and assigns, to hold and save harmless, from any loss, cost damage or expense, happening by reason of any defect or blockage of said sanitary sewer, the street commissioner or the City of Laconia, NH.
61. Attach a picture of a hand-drawn sketch here
    Include landmarks and distances.
63. I further agree not to discharge into the sanitary sewer any surface water, cellar water or water from rain conductors as decreed by City Ordinance.
65. 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.
67. Contractor Electronic Signature

69. Your application cannot be approved until we receive payment in full. A permit costs $330, unless you are a first time user. A permit for a first time user costs $1,130. We cannot accept credit card payment online or over the phone at this time. Checks (written to the "City of Laconia") can be dropped off at the DPW during business hours (Mon-Fri 7:30am-4:00pm) or can be mailed to: Laconia Department of Public Works, 27 Bisson Ave., Laconia, NH 03246.

73. Date of Permit Issue
74. Approved by
75. Permit Number
77. Date of Inspection
78. Inspection by
Leave This Blank:


80. Submit

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