Jerusalem, NY · Yates County
Application for Sewer Connection Permit
Property owners and contractors use this application to request a permit to connect a property to Keuka Park Sewer District facilities in the Town of Jerusalem.
What this form is
This application requests permission to connect a property to Keuka Park Sewer District facilities and records property, owner, billing, and emergency contact details. A sewer permit is required before work begins, and the form says a road opening permit may be needed before a sewer permit is issued. It also outlines inspection, insurance, and sewer easement requirements.
Who needs it
Property owners seeking a sewer connection permit, with contractors providing information and documentation required by the application, should use this form.
How to submit it
Return the completed application to the Keuka Park Sewer Department at 3816 Italy Hill Road, Branchport, NY 14418. The form lists application and other charges but gives no amounts.
About notarization
This application is signed and dated without a notary; the required sewer easement is signed by the property owner, with no notarization stated.
How to submit this form
- 1
Download The Application
Download the sewer connection permit application PDF.
- 2
Complete The Application
Enter the property, owner, billing, and contact information requested on the form.
- 3
Gather Required Items
Check whether a road opening permit, contractor insurance certificate, or sewer easement applies to your application.
- 4
Submit To The Department
Return the completed application to the Keuka Park Sewer Department at the address listed on the form.
Frequently asked questions
- Do I need a notary for the sewer connection permit application?
- No. The application is signed and dated without a notary. It also requires a property owner to sign a sewer easement, but does not state that the easement must be notarized.
- How do I submit the sewer connection permit application?
- Return the completed application to the Keuka Park Sewer Department at 3816 Italy Hill Road, Branchport, NY 14418.
- What information does the application ask for?
- It asks for property and tax map details, owner and billing information, telephone and email contacts, and signatures from the owner and contractor.
- What may be required before a sewer permit is issued?
- The form says a road opening permit may be required for excavation within a road right of way. It also requires a current insurance certificate from the contractor.
Need something notarized?
This Application for Sewer Connection Permit doesn’t need a notary — but if you have another Jerusalem form that does, a commissioned online notary can help.