The Jewett City Water Company
PO Box 1088, Enfield, CT 06083 Tel:(800)4308073
APPLICATION FOR WATER SERVICE
Service Account Information
(Please Print)
Service Address:_________________________________________________________________
(If no street address, then parcel number and lot number must be provided
)
Water Service Request:
New
Repair
Temporary
Size/Type:___________
Street Opening Permit Required
(will the work require excavating within the street layout)?:
Yes No
Authorized Installer:___________________________________________ Tel:________________
_____________________________________________________________________________________
Customer Information
Property Owner/Representative:
(Please Print)
Name: ___________________________________________________________ Tel: ______________
Address: _____________________________ City: ___________________ State: ____ ZIP: ________
The undersigned hereby makes application for a water service account with the JEWETT CITY WATER COMPANY at the above location. When
water is furnished in accordance with this application, the undersigned agrees to pay the rates established by the Company, and to observe and
be bound by its rules and regulations and any amendments thereof.
It is understood that this contract is in force until service is discontinued, or until the applicant notifies the JEWETT CITY WATER COMPANY in
writing that the service is to be discontinued.
___________________________________________
(Signature)
_____________________________________________________________________________________
New service cost: (Typical 1 inch service connection, includes tap, corp, curb stop, copper to curb stop, curb box)
Service connections are actual cost of materials and labor. Cost to be provided by Jewett City Water Company.
Meter pits and larger service connections are actual cost of materials, cost to be provided by Jewett City Water Company.
EXCAVATION FROM WATER MAIN TO CURB STOP TO BE DONE BY CONTRACTOR, HIRED AND PAID FOR BY WATER SERVICE APPLICANT.
FOR ALL PRIVATE WATER MAINS AND HYDRANTS THERE IS A SEMIANNUAL FIRE PROTECTION FEE.
FOR OFFICE USE ONLY
Amount Paid: _________________
Check Number: _________ Date Received: _________________
Application Approved:
Yes
No
Authorized Signature: _______________________________________________________
Date: ____________________
TOTAL ESTIMATED COST DUE BEFORE WORK TO START___________________(72 Hour Notice Required). Estimated Cost will be adjusted to actual
cost after completion of work.