Water Service Application

Applicants Name and Contact Information

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Last

Property Owner or Landlord's Name

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Last
Acknowledgment and Agreement.

I hereby agree that all the rules, regulations, conditions and provisions of any ordinance relating to the waterworks and sewerage system will be complied with; that all water and sewerage rates, assessments and rents and fines and penalties assessed, charged or imposed will be paid. A copy of the pertinent payment and collection provisions of the Water Services Ordinance has been made available to me.

I understand my payment of $75.00 Turn On Fee and $150.00 Deposit must be paid in the Chenoa City Office Prior to Date of Connection.