Rocky Mount, VA · Franklin County
Application for Water and/or Wastewater Connection
This application lets residents and businesses request a water connection, a wastewater connection, or both for a service address in Rocky Mount.
What this form is
Use this application to request a water and/or wastewater connection and provide the applicant’s name, service address, mailing address, phone number, and signature accepting the connection terms. The form says line availability and additional hookup fees are determined individually; it also lists connection and impact fees by meter size and location. A separate application is required for a water account deposit.
Who needs it
Residents and businesses seeking a water connection, wastewater connection, or both for a service address in Rocky Mount need this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; no notarized or sworn attachment is mentioned, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Application
Download the water and/or wastewater connection application.
- 2
Complete Applicant Details
Enter your name, service address, mailing address, and phone number, then sign to accept the connection terms.
- 3
Check The Deposit Requirement
If a water account deposit applies, note that the form requires a separate application for it.
- 4
Confirm How To Submit
The form does not state a submission method. Use its listed town contact details to confirm how to submit the application.
Frequently asked questions
- Do I need a notary for the water and wastewater connection application?
- No. The applicant signs the connection terms without a notary. The form does not mention a notarized or sworn attachment.
- How do I submit the connection application?
- The form does not specify a submission method. It lists the Town of Rocky Mount address, phone number, website, and email; contact the town to confirm how to submit it.
- What information does the application ask for?
- It asks for the applicant’s name, service address, mailing address, phone number, and signature accepting the connection terms.
- Is a separate application needed for a water account deposit?
- Yes. The form states that a separate application is required for the water account deposit.
Need something notarized?
This Application for Water and/or Wastewater Connection doesn’t need a notary — but if you have another Rocky Mount form that does, a commissioned online notary can help.