I, First Name Last Name , certify that I am the owner or an authorized agent of the owner of the above-described property and that the foregoing information is correct to the best of my knowledge. I agree to abide by the Rules and Regulations of the District which may be amended from time to time without notice and grant to the District the right to access the above-described property for the purposes of inspection and/or maintenance of the water meter, service lines, and any sanitary sewer pre-treatment facilities.