Blackstone, VA · Nottoway County
Water/Sewer Tap Fee Agreement
Property owners or responsible parties complete this agreement to describe proposed water or sewer connections and acknowledge charges for town-performed work.
What this form is
The Town of Blackstone Water/Sewer Tap Fee Agreement records details about a proposed water connection, sewer connection, or both. It asks for the applicant and activity address, connection and line sizes, distances, cleanouts, and a sketch of the proposed connections. The agreement also separates tap fees from estimated construction costs for work performed by the town and includes signature and date lines.
Who needs it
Property owners or responsible parties proposing water or sewer connections to town systems complete this agreement.
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; the applicant and owner or responsible party sign and date the agreement.
How to submit this form
- 1
Download The Agreement
Download the Water/Sewer Tap Fee Agreement PDF.
- 2
Complete The Applicant Details
Fill in the applicant name, activity address, connection type, line sizes, distances, and other requested information.
- 3
Add The Connection Sketch
Include a sketch showing the structure, mains, road right-of-way, proposed lines, cleanouts, and other necessary information.
- 4
Sign And Submit
Sign and date the agreement, then submit it to the city department named on the form.
Frequently asked questions
- What does the Water/Sewer Tap Fee Agreement ask for?
- It asks for applicant and activity address details, the type and size of proposed connections, distances, cleanouts, and a sketch. It also includes estimated town work costs and signature lines.
- Who completes this agreement?
- The agreement is for applicants proposing water connections, sewer connections, or both. It includes signature lines for the applicant and the owner or responsible party.
- Do I need a notary for the Water/Sewer Tap Fee Agreement?
- No. This document has no notary block; the applicant and owner or responsible party sign and date it.
- How do I submit the Water/Sewer Tap Fee Agreement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Water/Sewer Tap Fee Agreement doesn’t need a notary — but if you have another Blackstone form that does, a commissioned online notary can help.