Application for water service
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- Bu sahifa navigatsiya:
- Service Account Information
- Authorized Installer:___________________________________________ Tel:________________ _____________________________________________________________________________________
- EXCAVATION FROM WATER MAIN TO CURB STOP TO BE DONE BY CONTRACTOR, HIRED AND PAID FOR BY WATER SERVICE APPLICANT.
- TOTAL ESTIMATED COST DUE BEFORE WORK TO START___________________
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PO Box 1088, Enfield, CT 06083 Tel:(800)4308073
(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
(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.
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: ____________________
cost after completion of work. Katalog: forms forms -> Disability benefits questionnaire forms -> Bonita Nature Place Mission Statement forms -> Notice of nondiscrimination and grievance procedures forms -> Ace Hardware 1038 E. Michigan Avenue forms -> Atlanti c county forms -> Preamble preamble forms -> Registration form note: One form is needed for each unit Download 12.37 Kb. Do'stlaringiz bilan baham: |
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