Sewer Connection Application

UTILITIES, INC.

SEWER TAP & SERVICE INFORMATION FORM

APPLICANT INFORMATION:

    Name________________________________________________________________________

    Address _____________________________________________________________________

    City, State & Zip _______________________________________________________________

    Billing Address ________________________________________________________________

    (Needed only if different than address above)

    City, State & Zip _______________________________________________________________

    Home Telephone__________________________Business Telephone _____________________

BUILDING INFORMATION:

    Approximate Occupancy Date _____________________________________________________

    Legal Description _______________________________________________________________

    _____________________________________________________________________________

    _____________________________________________________________________________

    Street Address _________________________________________________________________

    Construction Type: Block _____ Brick _____ Frame _____ Other ___________________________

    Single Family _____ Multi-Family _____ Commercial _____ Other __________________________

    Water Meter Size _____ Number of Units _____ Number of Baths _____

BUILDER INFORMATION

    Name ________________________________________________________________________

    Address ______________________________________________________________________

    City, State & Zip _______________________________________________________________

    Business Telephone _____________________________________________________________

 

PLUMBING INFORMATION:

    Name ________________________________________________________________________

    Address ______________________________________________________________________

    City, State & Zip _______________________________________________________________

    Business Telephone _____________________________________________________________

NOTE: Two working days' notice must be given to Tierra Verde Utilities, Inc., for scheduling a required tap-in inspection.

FEES & CHARGES:

    Application Fee - $____________________________

    Inspection Fee - $_____________________________

    Connection Charge (Tap-in) - $___________________

    Total Due - $_________________________________

FEE IS NON TRANSFERABLE AND NON REFUNDABLE

CUSTOMER SIGNATURE:________________________________________________________________________________
(must be signed by the person responsible for billing charges - name that will appear on the account.)

TIERRA VERDE COMMUNITY ASSOCIATION REPR ___________________________________Approval Date_____________

UTILITY COMPANY REPR _______________________________________________________ Approval Date_____________

 

FOR OFFICE USE ONLY

 

Inspection Date___________By________________________________________________________________

Comments__________________________________________________________________________________

__________________________________________________________________________________________

 
 
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