Account #________________________
*This institution is an equal opportunity provider.
Courthouse Square
Beaufort, NC 28516
Application for Water Service
Carteret County’s water system is a publicly owned water system. In applying for water services you agree to abide by the rules and regulations including rates and fees as
set by the Board of Commissioners.
Water bills are due upon receipt and if paid by the due date specified on the bill, a penalty will not be charged.
It is the customer’s responsibility to maintain all plumbing for the meter into the house plumbing per building code requirements. Carteret County reserves the right to
discontinue service where plumbing is not maintained or is not in compliance with the NC State Building Code-Volume II, Plumbing
.
Please PRINT and complete ALL items:
Name: ___________________________________________
Driver’s Lic. #_________________________State:________
Telephone-Home ( ) ____________________________
Telephone-Work ( )_____________________________
Name: ___________________________________________
Driver’s Lic. #_________________________State:________
Telephone-Home ( ) ____________________________
Telephone-Work ( )_____________________________
911 Address: ______________________________________________________
City: ______________________________ State:_________________________Zip:___________
Mailing Address: (if different from property address)
Name: ____________________________________________________________ Primary Language Spoken at Home:
Street/PO Box: _____________________________________________________ English:
City: ______________________________________________________________ Spanish:
State: ______________________________ Zip: ___________________________ Other: _____________________
Is this a rental unit ( ) No ( ) Yes If yes, please complete the following information:
Owner’s Name/Address: ________________________________________________________________
Ty
pe of Service: ( ) Residential ( ) Commercial ( ) Other Size of Service: ( ) ¾” ( ) Other: ____
Have you had an account with us before? (____) No (____) Yes
Si
gnature: ________________________________ Signature: ________________________________
Date: ____________________________________
FOR OFFICE USE ONLY:
Fees: ( ) Tap Fee $ _____________ Prepaid Deposit: ________________
( ) Security Deposit $ _____________ Deposit: ________________
( ) Service Fee $ _____________
( ) Other $ _____________
Tot
al $ _____________
Mailing Address: 302 Courthouse Square, Beaufort , North Carolina 28516 Email: ashley.bennett@carteretcountync.gov or kim.young@carteretcountync.gov
