Bulk Water Application

Bulk Water Application

Annual Application
A Bulk Water Vendor shall be defined as follows: “A person or entity connected to the city’s water distribution system, conveying water in bulk principally for purposes other than the ordinary personal, household or commercial use of the residents of the City of Dickinson, and shall
specifically include any user of the city’s water distribution system principally designed to fill water trucks for agricultural or industrial use.” Dickinson City Ordinance No. 1394.
Owner Information/Applicant:
Company Name:*
Contact Person*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Water will be used for:*
Anticipated quantity used this year (Gallons per Day Avg.)*
Fees & Penalty
- Bulk water rates subject to change as approved by the City Commission listed on the
  City Fee Schedule
- Any person, who is found to have violated any provision of Section 38.20.030, or who has failed to comply with any other provision of this title and the orders, rules, regulations and permits issued hereunder, is guilty of an offense, and is subject to penalties as set forth in Section 25.20.010 of the Dickinson City Code, as may be amended from time to time. Each day on which a violation shall occur or continue shall be deemed a separate and distinct offense.
- The City reserves the right to shut off water service to any property connected to the
  city waterworks system at the discretion of the Board of City Commissioners
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Bulk Water Application

Owner Information/Applicant:

Fees & Penalty