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__________________________________________________________________________________

__________________________________________________________________________________________