LCU DEMOLITION FORM - LCU Service Request

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Sewer Disconnect

***Printed copies can be emailed to LCUNewInstalls@leegov.com or faxed to (239)485-8399***

Last Name*

First Name*

Middle Name

Service Address*

Apt/Unit

City*

State

Zip Code*

STRAP Number*

Directions to Job*

Residential/Commercial Structure

Cut and Cap existing wastewater service at right of way

Type of Structure*

Please describe Other*

Potable Water*

Please describe Other*

Irrigation Water*

Please describe Other*

Utility Provided Sewer *

Yes

Septic Tank *

Yes

Planned Date of Demolition*

Plumbing Contractor to be used for LCU Disconnect:

Last Name*

First Name*

Call for sewer lateral location here or 811.

Contact Inspector:
Jared Blake or Steffan Johnson
Phone: 239-533-8200
Email: JBLake@leegov.com AND SJohnson4@leegov.com

***Call/e-mail for inspection 24 hours in advance.***

Last Name*

First Name*

Phone Number*

Email*

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