Fillable Application for Membership and Water Use Data Sheet (CITY OF PIEDMONT)

Fill Online, Printable, Fillable, Blank Application for Membership and Water Use Data Sheet (CITY OF PIEDMONT) Form

Use Fill to complete blank online CITY OF PIEDMONT (OK) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Application for Membership and Water Use Data Sheet (CITY OF PIEDMONT)

On average this form takes 5 minutes to complete

The Application for Membership and Water Use Data Sheet (CITY OF PIEDMONT) form is 1 page long and contains:

  • 1 signature
  • 12 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for CITY OF PIEDMONT

BROWSE CITY OF PIEDMONT (OK) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City Of Piedmont
Application for Membership and
Water Use Data Sheet
A map of property is required for all unplatted applications.
A fee of $250 is required for all water studies.
Name of Applicant: ______________________________________________________________
Mailing Address: ________________________________________________________________
Address of Property: _____________________________________________________________
Legal Description (Required): ______________________________________________________
Phone Number: ________________________________________________________________
Are you the Homeowner or Builder? ☐ Homeowner or ☐ Builder
Is Property in a Subdivision? ☐ Yes or ☐ No
If Yes, Specify Name, Lot, and Block: ________________________________________________
Is the property in City Limits? ☐ Yes or ☐ No
Number of Persons Occupying Premises: ____________________________________________
Circle Use of Property: ☐ House ☐ Apt ☐Non-Residential Building ☐ Lot
☐ Farm ☐ Acreage
Source of Sewage Disposal: _______________________________________________________
The undersigned hereby applies to the Piedmont Municipal Authority for membership of water and/or waste disposal and hereby agrees that
upon approval of application, will comply with and be bound by all rule and regulations of the Piedmont Municipal Authority. The undersigned
also agrees to pay any and all fees, assessments, or other lawful amounts charged to members. All fees are non-refundable. Outside city limit
taps have a higher risk of being declined due to not meeting DEQ regulations and required fire flow. Upon approval of this application, applicant
will have 180 days from the date of the approval letter to pay for and finalize installation of the meter tap or the application will be forfeited.
Standard residential meter size is 5/8”.
______________________________________
Signature
______________________________________
Date
******************************************************************************
Office Use Only:
Received this ______ Day of _________________, 20_____. Receipt Number: ______________
Amount Paid: ____________ Cash: _________ Check: __________ Check Number: __________
Date Meter Set: _____________________ Meter Serial Number: _________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Application for Membership and Water Use Data Sheet (CITY OF PIEDMONT)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document