Jerusalem, NY · Yates County
Water Connection Permit Application
Property owners and contractors use this application to request a permit to connect a property to Keuka Park Water District facilities.
What this form is
This application requests a permit to connect a property to Keuka Park Water District facilities and records property, owner, billing, and contact details. The contractor must file a current insurance certificate meeting town requirements before the permit is issued. If the work involves excavation within a town, county, or state road right of way, the application requires proof of a road opening permit before issuance.
Who needs it
Property owners and contractors seeking a connection to Keuka Park Water District facilities need to complete this application.
How to submit it
Return the completed application to the Keuka Park Water Department at 3816 Italy Hill Road, Branchport, NY 14418.
About notarization
This application is signed and dated without a notary; it requires no notarized attachment or sworn step.
How to submit this form
- 1
Download The Application
Download the Water Connection Permit Application.
- 2
Complete The Application
Enter the property, owner, billing, and contact information, then provide the required owner and contractor signatures and dates.
- 3
Gather Required Documents
The contractor must file a current insurance certificate meeting town requirements. If excavating in a road right of way, obtain proof of a road opening permit.
- 4
Submit To The Water Department
Return the completed application to the Keuka Park Water Department at 3816 Italy Hill Road, Branchport, NY 14418.
Frequently asked questions
- Do I need a notary for the Water Connection Permit Application?
- No. This application is signed and dated without a notary, and the document does not require a notarized attachment or sworn step.
- How do I submit the Water Connection Permit Application?
- Return the completed application to the Keuka Park Water Department at 3816 Italy Hill Road, Branchport, NY 14418.
- What must the contractor provide before the permit is issued?
- The contractor must present and file a valid current insurance certificate meeting town requirements with the water clerk before the town issues the permit.
- Is a road opening permit always required?
- The application says a road opening permit is required before a water permit is issued if work involves excavation within a town, county, or state road right of way.
Need something notarized?
This Water Connection Permit Application doesn’t need a notary — but if you have another Jerusalem form that does, a commissioned online notary can help.