Water Service Application "*" indicates required fields Assessor’s Map No.*Lot No.*Modify existing Service-explain:*I hereby make application for water service at…and agree to abide by the rules of COMM Water Department.* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name of Owner as per Deed:* First Last Billing Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Owner’s Service Installer (from the approved list)*Please provide a drawing plan of existing conditions (septic, private lines, well etc.)*Max. file size: 24 MB. System Development Charge: $*Owner’s Consent* I Consent Will a Fire Sprinkler System be installed?* Yes No Pumper connection(s)?* Yes No Are there chemical additives?* Yes No Type of approved device installed* RPZ DCVA Degree of hazard* High Moderate Low Will a Lawn Sprinkler be installed?* Yes No Type of approved device* RPZ DCVA PVB Is the dwelling currently on a private well?* Yes No Is it connected?* Yes No Δ
