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__________________________________________________________________________________
__________________________________________________________________________________________
