Notice Of Consent To Turn On Village Water Supply

Village of Fultonville

PO Box 337

Fultonville, NY 12072

Phone 518-853-3815

Fax 518-853-4813

 

Linda Petterson-Law, Mayor                                                                          Robyn Rose, Deputy Mayor

 

ACCOUNT #                      

Notice of Consent to TURN ON Village Water Supply

THERE IS A $30.00 CHARGE FOR THIS SERVICE

 

This document serves as notice to the interested parties of the Village of Fultonville that I/we wish to be served with water from the municipal water supply of the Village of Fultonville. Accordingly, a water meter reading will be taken, if applicable, and a water bill issued for the amount of water used, based on an actual meter reading, billed at the next regular billing cycle, of which I/we agree to pay without penalty within 30 days of receipt of same. Water will not be turned on until property is inspected by the Water Superintendent and a Village approved water meter is installed. After 30 days a 10% penalty will be applied as prescribed by the rules and regulation governing water usage that are currently in effect. Sewer charges, if any, will continue according to the sewer ordinance, even if no water is used. Upon failure to pay these charges within the current fiscal year they will be relevied to the Village property tax bill, _______(sbl#).

 

                                                                                                                                                           

                                                                                                                        Signature

 

Name:                                                                         Property Location:                                         

 

Billing Address:                                                          Phone #:                                                         

 

                                                                                    Date:                                                              

*** For Office Use Only: Work Order #                     ***

 

 

Date Notice Receive:                                                              Meter Serial #                                                

 

Water Meter Reading:                                                            Date Read:                                                     

 

Turn on fee Paid:                     Billed:             Bill Date:                  

 

This certifies that water service has been turned on, with a functioning water meter installed, as prescribed by the above notice on this date.

 

Date:                                                                                                                                                                                                                                                                                                    DPW Superintendent

 

Entered into BAS: Date                                                                                          By:                                                                                          

^{4/17/2018 2:15:10 PM}