Water & Sewer Application

Description

Water Authority of Dickson County 101 Cowan Road Dickson, Tennessee 37055 Application for Water and Sewer Service Service Account No:______________________ Date of Application:_______________________ The undersigned person(s) (the “Applicant”) hereby make(s) application to the Water Authority of Dickson County (the “Authority”) for the Authority to supply water and (where available) sewer service (such service(s) are collectively and individually referred to herein as the “Service”) at the below-described location (the “Service Location”): Service Address: ___________________________________ Tax Map No: ___________________________________ Billing Address: ___________________________________ The Applicant is the (check one) Owner: Renter: Date of Service Connection (“Service Date”): ____________________ 1. By signing and submitting this application, the Applicant certifies, warrants, and represents to the Authority that each and all of the following are and will remain true and correct: a. The Applicant submits this application for and on the Applicant’s own behalf, and not for or on behalf of any other person occupying the Service Location, other than the Applicant’s spouse (if applicable), except as otherwise disclosed by the Applicant on this form; b. Neither the Applicant nor the Applicant’s spouse, nor any other occupant of the Service Location, nor any person for whose debts the Applicant is legally responsible owes the Authority or any of the Authority’s predecessors in interest any money for prior Service or for any other reason; c. The Applicant is the owner and occupant of the Service Location; alternatively, the Applicant is a bona fide tenant occupying the Service Location and is authorized by agreement with the landlord to submit this application; alternatively, the Applicant is the bona fide occupant of the Service Location and is authorized by other agreement to submit this application on behalf of the owner(s) of the Service Location; d. The Applicant has inspected the plumbing and plumbing fixtures in the Service Location, and the same are or will be no later than the Service Date ready and in a condition for Service to be provided immediately (that is, all faucets turned off, all drains open and operable, and no leaks or breaks in pipes known or suspected); and, e.