Evidence Of Compliance Certificate - Dye Testing Form - The Pittsburgh Water And Sewer Authority

Download a blank fillable Evidence Of Compliance Certificate - Dye Testing Form - The Pittsburgh Water And Sewer Authority in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Evidence Of Compliance Certificate - Dye Testing Form - The Pittsburgh Water And Sewer Authority with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

THE PITTSBURGH WATER AND SEWER AUTHORITY
_____________________________________________________________________________________________________________________________________
David L. Donahoe
Penn Liberty Plaza I
Interim Executive Director
1200 Penn Avenue
Pittsburgh, PA 15222
412 255-0801
FAX: 412 393-0517
EVIDENCE OF COMPLIANCE CERTIFICATE – DYE TESTING
Date of Application: ______________ Ward: _______ Allegheny County Parcel ID: _____________________________
Property Address: ____________________________________________________________ Zip Code: _____________
Owner’s Name: ___________________________________________________________ Phone: ___________________
Owner’s Address: ____________________________________________________________ Zip Code: _____________
Contact Name or Company: _________________________________________________ Phone: ___________________
Mailing Address for Approved Certificate: _______________________________________________________________
Please return completed application along with a self addressed envelope and check or money order for $25 made payable
to The Pittsburgh Water and Sewer Authority:
Date Received
Attn: Dye Testing
The Pittsburgh Water and Sewer Authority
Penn Liberty Plaza I
1200 Penn Avenue
Pittsburgh, PA 15222
_________________________________________________________________________________________________
THIS SECTION TO BE COMPLETED BY PWSA
This is to certify that the property located at: ________________________________________________________
______ Is NOT located in a sanitary sewer area and a dye test is NOT REQUIRED.
______ Is located in a sanitary sewer area and a dye test has been performed. A registered plumber has certified that
there are NO storm or surface water drains connected to the sanitary sewer system.
______ Is located in a sanitary sewer area and a dye test has been performed. A registered plumber has certified that
this property has failed the dye test. Corrective actions have been completed and a registered plumber has certified that
there are NO storm or surface water drains connected to the sanitary sewer system.
Reviewed by: __________________________________
Seal:
Title: _________________________________________
Signature: _____________________________________
Date: ____________________________
This Evidence of Compliance Certificate shall expire three (3) years following the date of issuance.
REV 3/2016

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Pt-139 - Water And Sewer Companies Property Tax Return Form Pt-139 - Water And Sewer Companies Property Tax Return Financial
Form Pt-139 - Water And Sewer Companies Property Tax Return Form Pt-139 - Water And Sewer Companies Property Tax Return Financial
Exhibit K-1 - Previous Development Compliance Certificate Template - South Carolina State Housing Finance And Development Authority Exhibit K-1 - Previous Development Compliance Certificate Template - South Carolina State Housing Finance And Development Authority Legal
Form Cd-318 - Franchise Tax Return For Water And Sewer Companies - North Carolina Department Of Revenue Form Cd-318 - Franchise Tax Return For Water And Sewer Companies - North Carolina Department Of Revenue Financial
Form Bcs-7crf - Customer Registration For Water And Sewer Billing Form Bcs-7crf - Customer Registration For Water And Sewer Billing Legal
Form Cd-318 - Franchise Tax Return Water And Sewer Companies Form Cd-318 - Franchise Tax Return Water And Sewer Companies Financial
Form Lst 2 - Employee's Evidence Of Deduction Certificate - City Of Lock Haven Tax Office Form Lst 2 - Employee's Evidence Of Deduction Certificate - City Of Lock Haven Tax Office Financial
Certificate Of Compliance With 10 Usc Form Certificate Of Compliance With 10 Usc Form Business
Form Nj-1065 - New Jersey Division Of Revenue E-file Registration Form For Software Developers And/or Transmitters - 2002 Form Nj-1065 - New Jersey Division Of Revenue E-file Registration Form For Software Developers And/or Transmitters - 2002 Financial
Letter Of Authorization Regarding Water And Sewer Account Letter Of Authorization Regarding Water And Sewer Account Letters

Related Categories

Parent category: Business
Download
Go