Utility Tap Application – City of Walhalla

911 Address of the PROPERTY to be served*

Street Address City State ZIP Code

Name of Subdivision

Lot #

Tax Map #*

Check type of water and/or sewer service requested:*

Residential
Irrigation
Industrial / Commercial
Farm

Size of water meter requested*

Size of sewer service requested

Directions to site, be specific*

Describe what will be served by this tap (# of bedrooms, type of business, etc.)*

Name of Applicant*

First Last

Phone*

Mailing Address of the Applicant*

Street Address Address Line 2 City State ZIP Code

Owner of property where meter or sewer tap is to be placed*

First Last

If applicant does not own property, notarized easements must be obtained in the City’s name PRIOR to making payment for tap. Meters cannot be placed on road right of way. Easements for the line from meter to house are the owner’s responsibility, the City is not responsible for private service lines. The tap location MUST be flagged for inspection by the City. If we move tap location, you will be notified. Flags are to be placed approximately 33’ from the center of the road, at least 10’ from the property corners, and away from shrubs, trees, walls, drains, poles, guy wires, fences, or utility boxes. If there are obstructions on the site, THE OWNER is responsible for removal/relocation of obstructions. The City is not responsible for any damages to the obstructions during installation of tap. The disturbed area will be raked and fescue and/or rye grass seed and straw applied for ground cover. NO SPECIALTY GRASSES WILL BE USED. No payment is due until the application is approved by the City. ALL irrigation taps require a backflow device, which must be installed and tested annually by the owner.

Consent*

By checking this box I acknowledge that I have read the terms above and have willing filled out and agreed to entering a contract for service. Put your initials in the box below and that will act as your signature.

I consent and agree

Initials (First and Last)*

CITY OF WALHALLA Utility Tap Application