Application for service

What Rural Water District or Public Works Authority are you applying for service in*

Benefit Unit Cost*

Feasibility Study Cost*

Full Name*

Mailing Address*

Mailing Address

Street Address Line 2

CityStateZip

Primary Phone*

Alternative Phone*

Email*

example@example.com

Service Address*

Street Address

Street Address Line 2

CityStateZip

Legal Description of the property being served*

Driving Directions to where you want the meter installed*

Does Applicant own the land where benefit unit will be installed?*

YesNo

Has this property been split from a larger tract of land?*

YesNoUnknown

Is the applicant planning on dividing land in the future?*

YesNoMaybe

Is the tract of land less than 5 acres?*

YesNoMaybe

What is the purpose of the Benefit Unit?*

ResidentialCommercialAgricultural

If Commercial what is the nature of the commercial business*

Does the applicant own another benefit unit?*

YesNo

Location number of existing benefit unit?*

What is the expected average monthly water usage in gallons*

All new benefit unit applications require a feasibility study at a price of (listed above) and each new application is subject to a 60-day waiting period.*

Acknowledge

purchase or cause to be purchased one benefit unit for each water service at the unit price of (listed above) (A benefit unit entitles the holder to one water service connection). Applicant agrees to pay any additional extension charges. All system construction is performed by the District or its contractor*

Acknowledge

purchase or cause to be purchased one benefit unit for each water service at the unit price of (listed above) (A benefit unit entitles the holder to one water service connection). Applicant agrees to pay any additional extension charges. All system construction is performed by the District or its contractor*

Acknowledge

Water meters will be read by the District and a service bill for water used shall be rendered by the District on or around the 1stday of the month following the month in which the water is used, and the undersigned agrees to pay said service bill on or before the 20th day of the month in which the bill is rendered, or be subject to a late charge of 10 percent. Failure of the District to submit a service bill shall not excuse the undersigned from his obligation to pay for the water used when the bill is submitted. Failure to pay a bill by the first day of the month following the month in which the bill is rendered shall result in discontinuance of the service.*

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Representatives of the District shall have the right at all reasonable hours to enter upon consumers` premises to read and test meters, inspect piping, and to perform other duties for the proper maintenance and operation of service, or to remove its 'meters and equipment upon discontinuance of service by consumers..*

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The water service supplied by the District shall be for the sole use of the undersigned; the undersigned agrees that he will not extend or permit the extension of pipes for the purpose of transferring water from one property to another, nor will he share, resell, or sub-meter water to any other consumer. Each meter service shall supply water to only one residence or business establishment. All new meters shall be located on the property receiving the water service from the District.*

Acknowledge

The water service supplied by the District shall be for the sole use of the undersigned; the undersigned agrees that he will not extend or permit the extension of pipes for the purpose of transferring water from one property to another, nor will he share, resell, or sub-meter water to any other consumer. Each meter service shall supply water to only one residence or business establishment. All new meters shall be located on the property receiving the water service from the District.*

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The undersigned agrees that he will make no physical connection between any private water system and the water system of the District. Representatives of the District may at any reasonable time come on the premises where the water is being used for the purpose of making inspection to enforce this provision. Violation of this provision shall be grounds for disconnection of service.*

Acknowledge

The laws of the State of Oklahoma, the By-Laws of the District, and Rules and Regulations of the District, as presently existing, and as may be amended from time to time, are made a part of this agreement as though fully set out herein.*

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If a structure is placed at this location to house people it must have a sewage disposal system approved by the Department of Environmental Quality. Failure to provide documentation of such a system shall be reason to remove the water meter and forfeit all rights and monies to the water district.*

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Each application for water service, when approved, shall be a covenant by all owners of perpetual easement for location of District main or lateral service lines upon the lands of said owners, without additional compensation, and whether or not fully described hereinabove. The District will normally locate lines about five feet inside the fence line, but reasonable variation is contemplated*

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If the water service connection is to provide water to a residence or a business, applicant agrees to provide the District with a proper percolation test as required by the Oklahoma State Department of Health, before the service is installed in accordance with the percolation test design and that an inspection will be requested from the County Sanitarian before the system is covered*

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Water service installed as only a pasture tap for animal or garden use requires a letter from the Oklahoma State Department of Health stating the District has the Authority to serve water*

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Such installation must comply with Oklahoma State Department of Health Rules & Regulations regarding potential siphoning back to water system. Applicant agrees that should a resident or business be connected to the service in the future, proper procedures will be followed with regard to the State Health Department approval of the Sewage System. Failure to do so shall result in a discontinuance of service.*

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The District requests pre-payment of benefit units. The District will allow benefit units costs to be paid in installments, the first benefit unit installment is $1,000 and due with the Application and the remaining payments ($500.00 each) are due on the 20thof each month following approval of the Application unless specific authorization from the Board of Directors is received to deviate from this schedule. If any payment is received after the due date, a 1.5% per month late fee will be charged on the entire outstanding balance*

Acknowledge

The District requests pre-payment of benefit units. The District will allow benefit units costs to be paid in installments, the first benefit unit installment is $1,000 and due with the Application and the remaining payments ($500.00 each) are due on the 20thof each month following approval of the Application unless specific authorization from the Board of Directors is received to deviate from this schedule. If any payment is received after the due date, a 1.5% per month late fee will be charged on the entire outstanding balance*

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The District requires payment in full of extension cost on availability of service and reserves the right to require some payment before construction begins. Extension charge not made within thirty days of completion of the extension will be assessed a 1.5%per month late fee*

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File Upload*

Must upload a copy of the applicant's driver's license and a copy of paperwork showing ownership of the property where the meter will be installed

Signature*

Date*

Date

The Board of Directors takes the following action regarding this application;

PLEASE ACKNOWLEDGE EACH OF THE FOLLOWING: