HomeMy WebLinkAboutWater Service Application.pdfMAPLE RIDGE
9riiish Celum6ii
City of Maple Ridge
Engineering Department
Address: 11995 Haney Place, Maple Ridge BC V2X 6A9 Phone: 604-467-7339 Fax: 604-467-7461 email: engineering@mapleridge.ca
APPLICATION FOR WATER SERVICE ESTIMATE
CIVIC ADDRESS OF PROPERTY
LEGAL ADDRESS OF PROPERTY
(LOT AND PLAN NUMBERS)
APPLICANT
(PROPERTY OWNER)
ADDRESS
DATE OF APPLICATION
POSTAL CODE
PHONE
EMAIL/FAX
PLEASE FILL IN OR CHECK APPROPRIATE BOXES
PIPE
SIZE
(mm)
NEW
BLDG
EXISTING
BLDG
SINGLE
FAMILY
MULTI
FAMILY
COMMERCIAL
LOCATION
STAKED
ESTIMATES
OFFICE USE
ONLY
WATER CONNECTION
$
PERMANENT DISCONNECT
TEMPORARY DISCONNECT
$
METER BOX REQUIRED
$
OTHER
REQUEST WATER METER ON EXISTING SERVICE CONNECTION
SUB -TOTAL
$
GST
$
TOTAL ESTIMATE
$
TERMS AND CONDITIONS:
I agree that I will comply with all City of Maple Ridge by-laws, including the following: streets and traffic, sediment control, water, Maple Ridge
sanitary sewer regulations by-law, Maple Ridge storm drainage system extension regulations by-law and Greater Vancouver Sewerage and
Drainage District sewer use by-law and amendments thereto in so far as they apply to my requirements and use. I also agree to save the
City, its elected and appointed officials, employees and agents harmless from and against all liability, actions, causes of action, claims
damages, expenses, costs, debts, demands or losses suffered or incurred by them or any of them, including consequential damages and
damages to third parties whether known or unknown, foreseeable or not, arising from the installation and use of the service connection. The
municipality reserves the right to charge the applicant for any additional costs incurred due to problems encountered, which at the time of
the estimate were not known by the City. Payment of the connection fee must be made two (2) weeks prior to installation. Please make
cheques payable to the City of Maple Ridge.
**A stake must be placed and marked with paint where the service is required.
Note: This application for service estimate is valid for sixty_(60) days only from date of estimate.
OWNERS SIGNATURE: DATE: