Wilkinsonville Water District
WILKINSONVILLE WATER DISTRICT
13A Providence Road • P.O. Box 173 Sutton, MA 01590 508-865-0060 Fax: 508-865-5993
WATER CONNECTION PERMIT APPLICATION
APPLICATION FEES MUST ACCOMPANY PERMIT APPLICATION.
I. Owner Information
Name:___________________________________________________________________________________
Address:_________________________________________________________________________________
Phone:__________________________________________Ext:_____________________________________
Contractor:______________________________________________________________________________
Contractor Phone:_______________________________________________________________________
Building Location:_______________________________________________________________________
By applying for this connection, I agree to abide by all applicable town, state, and federal requirements.
Signature:_______________________________________________________________________________
Agent for owner - If different from above, include address and telephone number:__________
__________________________________________________________________________________________
Please Note:
It will be the responsibility of the applicant to provide meter fittings for 5/8", 3/4", and l" meters. Fittings for I .5" and 2" meters will still be provided by Wilkinsonville Water District.
Meter size: Fire service size: Private hydrant:
Back flow preventer: Yes No Pressure reducing valve: Yes No
For office use:
2a.PERMIT FEE: Amount:________________________
Date:________________ Receipt #:______________ Received by:_______________
2b. SYSTEM DEVELOPMENT FEE: Amount:____________________
Date:______________ Receipt #: ________________ Received by:______________
3. METER SIZE:____________________
SERVICE TYPE: New Renewed Meter Only