Sewer Repair Permit Application – Holly Hills Sanitation District

Application for Sewer Service Line Repair or Replacement Permit

Homeowner Information:

Name

Address

Phone Number

Email

I am the applicant

Contractor Information:

Name

Address

Phone Number

Email

I am the applicant

I have paid the $150 permit fee

Please mail the check to: Holly Hills Water and Sanitation District, 2801 Youngfield St. #370, Golden, CO 80401

I have secured a $10,000 license and permit bond, naming Holly Hills Water and Sanitation District as Obligee

Please attach a copy of the bond when submitting this form:

IMPORTANT: It is the responsibility of the applicant to schedule an inspection by the District prior to completing the work. Failure to do so may result in the District excavating and inspecting the work at the cost of the homeowner.