Sanitary Sewer Lateral Repair Program Application Please enable JavaScript in your browser to complete this form.Please read the Sanitary Sewer Lateral Repair Program Policy before submitting application. Property Owner Name *FirstLast File Attempted who Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmailName of Contractor who Attempted to Clean the Line *FirstLastName of Contractor (if different) who Performed Cabling, Dye Testing or Televising of LineFirstLastIs the problem under a street of sidewalk? *YesNoUnknownHas Metropolitan Sewer District or St. Louis County Health Department been contacted? *YesNoUnknownHas the problem been cabled, dye tested and/or televised? *YesNoUnknownHas the entire line been scoped upon completion of repair? *YesNoUnknownA Plumber Verification form (provided by City Hall) must be attached or provided to City Hall. Indicate date, time and precise location of where in the service line the procedure took place. A signed release form (provided by City Hall) must be attached or provided to City Hall. Note: The property owner must complete final site restoration (such as landscaping). File Upload Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. Submit
