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