2. I & I Sewer Lateral Contact Information Form
4. Owner's 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. PLEASE DO NOT UPLOAD VIDEO WITHOUT COMPLETING ALL CONTACT INFORMATION.

    
    

    Label your video with your property address. Failure to do this will delay process.

17. Inspection video
    Upload video here (required)

    *Video requirements*

    Only videos containing time and location stamp will be accepted.

19. Is this a rental property?*

    1. Yes
    2. No
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field