I have read this information, understand the risks, and refuse to give the City of Crown Point and/or their Contractor permission to replace the water service line at my property in the yard from the meter to premise plumbing. I understand that state and/or federal regulations may require my property be regularly notified regarding the potential unsafe conditions due to lead materials in my service line. I understand that appropriate disclosure may be required upon the sale, exchange, installment of land sale contract, assignment of beneficial interest, lease with an option to purchase, ground lease or assignment of ground lease of the property. I also understand that updated state and/or federal regulations may list my property in a public database identifying lead service line locations.

I have read this information, understand the risks, and give the City of Crown Point representatives or contractors, permission to enter upon the premises identified to replace the existing private portion of the water service line which extends from the water meter. In order to complete the project, I agree to allow access to the existing water supply system, the existing driveway, lawn areas, and basement, crawl space, or building area, as needed until the work is complete. I understand this may be including but not limited to the removal of trees, shrubs, and other foliage needed to access the service line. Upon completion of the service line installation, the surface of the property shall be restored to existing or better condition by the construction contractor. Areas where impeding vegetation is removed will be seeded with grass. I will notify all occupants and tenants of the property of the information provided about the project. Water flushing or other instructions will be provided in advance of construction via door hanger, flyer and/or to the email address below. I acknowledge by signing this agreement that replacement of the private water service line does not constitute any further responsibility of this private water service line by the City of Crown Point. However, the City of Crown Point will guarantee the private service line for One (1) year after construction.

By signing below, Owner represents and warrants that Owner is the lawful fee title Owner of the Property and thus has full right, power, authorization, and capacity to permit this right of entry. The private service line and interior plumbing remains the private property of the Owner and continues to be the full responsibility of the Owner at all times now and in the future.