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2. Application for New Water and Sewer Tap

   City of Bristol, Tennessee

   Return completed application to P.O. Box 1189, Bristol, TN 37621 (mail) or [email protected] (email) or click submit below. 

4. Date
6. Service Address
8. Tax Parcel Number
10. Inside City limits

    1. Yes
    2. No
11. Outside City Limits

    1. Yes
    2. No
12. Is the property currently connected to a well?

    1. Yes
    2. No
13. Is the property currently connected to a septic system?

    1. Yes
    2. No
15. Name
17. Billing Address
19. Phone Number
20. Email Address
22. Site Contact Name (If different from above)
23. Site Contact Phone Number
25. RESIDENTIAL UTILITY SERVICE CONNECTION – SINGLE FAMILY
27. Single-Family Water Tap

    1. 3/4"

    1. 1"
29. Irrigation Water Tap Size (check one)

    1. 3/4"

    1. 1" *backflow prevention devices required on irrigation lines.
31. Single-Family Sanitary Sewer Tap

    1. 4"
33. RESIDENTIAL UTILITY SERVICE CONNECTION – MULTI-FAMILY
35. Multi-Family Water Tap: # Units:
36. Tap size (Check One):

    1. 1"
    2. 1 1/2"

    1. 2"
    2. 3"

    1. 4"
38. Irrigation Water Tap Size (check one):

    1. 3/4"

    1. 1"

    1. 1 1/2"

    1. 2" *backflow prevention devices required on irrigation lines.
40. Fireline Tap Size (if required, check one):

    1. 3/4"
    2. 1"

    1. 1 1/2"
    2. 2"

    1. 3"
    2. 4"
42. Multi-Family Sanitary Sewer Tap (check one):

    1. 4"

    1. 6"
44. COMMERCIAL UTILITY SERVICE CONNECTION
46. Type of Establishment:

    1. Retail

    1. Restaurant

    1. Office

    1. Other (please describe below)
48. If other, please describe
50. Domestic Water Service Tap Size (check one):

    1. 3/4"
    2. 1"

    1. 1 1/2"
    2. 2"

    1. 3"
    2. 4"

    1. 6"
52. Irrigation Water Service Tap Size (check one):

    1. 3/4"

    1. 1"

    1. 1 1/2"

    1. 2"
54. Fireline Tap Size (if required):

    1. 3/4"
    2. 1"

    1. 1 1/2"
    2. 2"

    1. 3"
    2. 4"

    1. 6"
56. Sanitary Sewer Tap (check one):

    1. 4"

    1. 6"
57. Grease Trap Required by Code?

    1. Yes

    1. No
59. *Backflow prevention devices (BFPs) required on customer side of all commercial water service connections.
61. INDUSTRIAL UTILITY SERVICE CONNECTION

    *Please contact the Director of Utility Services for information on water/sewer connections for industrial facilities.

65. FOR INTERNAL USE ONLY:
74. COPY TO:

    Customer Service
    Utility Maintenance Division 

Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field