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2. I & I Sewer Lateral Contact Information Form
4. Name*
5. Email Address to send certificate/correction notice to*
7. Address of property televised*
9. City
10. State
11. Zip Code
13. Phone Number*
15. Inspection video *
    Upload video here (required)
17. Is this a rental property?*

    1. Yes
    2. No
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field