Fillable Application For Water Service

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Application For Water Service

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Country of origin: US
File type: PDF

U.S.A. forms for Borough of Greencastle

BROWSE BOROUGH OF GREENCASTLE (PA) FORMS

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Greencastle Area, Franklin County Water Authority
60 N. Washington Street - Greencastle, PA 17225 – Phone 717-597-7143
Application for Water Service
Date:
No:
N/A
(Please Print)
located at
17225, hereby make application to the Greencastle Area, Franklin County, Water Authority for
water service to said premises to be used for domestic purposes through a ¾ inch service pipe
and a ¾ inch corporation cock. I hereby agree to comply with the RULES AND
REGULATIONS AND WATER RATES of the Greencastle Area, Franklin County, Water
Authority, Greencastle, Pennsylvania.
Applicant & Owner
X
(print name)
x
(signature)
Address:
X
X
Phone #
X
----------------------------------------------------------------------------------------------------
AUTHORITY USE ONLY
Date Connection Fee Paid___N/A____________
06.378.110
Connection Fees
$
06.378.120
Fire Lines
$
06.378.130
Tapping Fees – Capacity
$
06.378.140
Tapping Fees – Distribution
$
06.378.150
Special Purpose Fee – High Service Area
$
06.378.160
Tapping Fee –Reimb. Part to Dev.
High Service Area
$
Note: water meter and supplies will be billed separately
Basement?
Yes
No
Account Number
Date __________________
Permit No._______ _____________ ________________________________
Authority Manager
I,
,
the owner of the premises
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Application For Water Service

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Completed 12 July 2020

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