Fillable APPLICATION FOR SERVICE (City of Detroit - ITSD)

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APPLICATION FOR SERVICE (City of Detroit - ITSD)

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The APPLICATION FOR SERVICE (City of Detroit - ITSD) form is 2 pages long and contains:

  • 0 signatures
  • 1 check-box
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Detroit - ITSD

BROWSE CITY OF DETROIT - ITSD (MI) FORMS

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B
usiness Name/DBA (if applies):
First Name:
M
iddle Initial:
L
ast Name:
Driver’s License/State ID Number:
Ex
piration (MM/YYYY):
Date of Birth (MM/DD/YYYY):
Mailing Address:
City:
State:
Z
ip Code:
Phone Number:
Al
ternate Phone Number:
B
est Time to Contact Applicant:
Email: *Social Security Number (Last Four):
Co-Applicant First Name: Middle Initial: Co-Applicant Last Name:
Property Information
Address to Start Water Service:
City:
State:
Zip Code:
Closing Date (MM/DD/YYYY):
Start Service Date (MM/DD/YYYY):
Will you own or rent the property:
Rent
Own
Type of Property:
Residential
Two-Family Flat
Commercial
Duplex
* If you do not have a Social Security Number, a customer service representative will contact you for documenting other acceptable forms of identification.
Applicant Information
APPLICATION FOR SERVICE
By signing this document you represent that you are authorized to request water and sewerage service at the
property address below. Your signature and acceptance of water and sewerage services means you agree to the
following terms and conditions of the Detroit Water & Sewerage Department (DWSD) for the duration of service:
•
I will pay all applicable rates and charges for water, sewerage and drainage charges as established from time to time by the Board of Water
Commissioners, and that said charges shall be a lien against the property and become effective immediately upon service to the property unless
proper proof of tenant’s responsibility to pay is on file with DWSD.
•
I understand and agree that payment of rates and charges must be paid by the due date shown on the bill. In the event of late payment, penalties will
be imposed.
•
I understand that if my account becomes delinquent, DWSD may interrupt service until the account is paid in full or I enter into an approved
payment plan. A reconnection charge may be imposed. DWSD may transfer its lien to the property tax roll for collection of the delinquent balance as
provided by law. DWSD may also elect to sue for collection of delinquent amounts owed.
•
I understand service activation will require a deposit. If the account is not delinquent, deposits will be returned after the account has been closed
upon request.
•
I agree to provide valid identification and a Social Security or Tax Identification Number. Non-U.S. Citizens must provide photo identification.
•
I agree to notify DWSD when moving from (vacating) a property.
•
I understand that water service will not be turned on until an Automatic Meter Reading (AMR) meter is installed and that the property owner,
landlord or tenant is responsible for making necessary plumbing repairs to support installation of AMR services.
•
I will not allow any person other than an authorized representative of DWSD to connect or reconnect water services.
•
I will not allow any person other than an authorized representative of the DWSD to operate, or cause to be operated, any valve in or connected
with a water main, water service, or fire hydrant, or to tamper with or otherwise interfere with any water meter, detector check valve, or other part
of the water system.
•
If DWSD detects a device, scheme, or tampering that avoids or attempts to avoid full payment for water service, I may be subject to fines, service
interruption and/or immediate removal of utility equipment and service from the premises or legal action.
•
I agree to keep the area around DWSD’s meter clean and free of hazardous materials and I agree to provide safe access to DWSD employees to enter
the premises at any reasonable time to read, install, remove, exchange, maintain, test or upgrade the water meter and associated devices.
•
I understand that the property owner is responsible for the water service line from the water meter to the curbstop (turn-on/turn-off valve) near the
sidewalk. DWSD is responsible for the portion from the curbstop to the water main.
Applicant Name Property Address Date
☐
By clicking this checkbox you are providing an e-signature equivalent
and agreeing to the DWSD Terms and Conditions. Leaving the checkbox
unchecked will result in this application not being processed (?).
DWSD’s Terms of Service are based on Michigan Act 178 of 1939, Municipal Water Liens (MCL 123.161, et. seq.), Chapter 56, Utilities, of the Detroit City Code and Michigan Act 206 of
1893, The General Property Tax Act (MCL 211.1, et. seq.)
WATER AND SEWER ACCOUNT
TERMS AND CONDITIONS
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APPLICATION FOR SERVICE (City of Detroit - ITSD)

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Completed 8 January 2022

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