N
CIT
Y OF EDGEWATER
Application/Agreement For Reclaimed Water Service
PART ONE
Owner's
Name _________________________________________ Date ____________________
Service Address _________________________________________
Phone#__________________
Utility B
illing Account
N
umber ________________________
Property Description: Lot ________
_____________________ Block ______________________
Typ
e of Service Re
quested:
Irrigation
Hose
Single Family Duplex Commercial
(Owner)
Payment Amount Received:$_________________________
Received by: _________________________________________ Date______________
(City Representative)
PART FIVE
INSTALLATION DATE____________ LOCATION_____________________
______
_______
___ ___
_____
Duplex or Commercial-Increased connection and monthly fee may apply.
(Sketch)
PART TWO
Initial Approval - Utility Department_______ Date__________ Connection Fee/Down Payment $________
PART THREE
I, the Applicant/Owner, hereby acknowledge receipt of the City of Edgewater’s Policies and Procedures Information Packet relating to
Reclaimed Water Service and Water Conservation, and hereby agree to restrict the use of reclaimed water for the purpose(s) described in this
application/agreement and abide with the current and any amended City and State Rules and Regulations.
Even though the City of Edgewater will make every effort to provide a continuous supply of reclaimed water, I understand and acknowledge that there may be
various times during dry weather (or drought) periods, excessive use of the system, or for maintenance/improvements to the system that the reclaimed
water may not be available for my personal use.
I further agree, the City will not be held liable for damages that may occur to vegetation or which may occur due to uses of reclaimed water for
purposes not included in this application, and agree to defend and hold harmless the City of Edgewater from all claims and judgments arising against the City
by any person.
The City shall have the right to enter the above premises to inspect the reclaimed water piping and fittings, to discontinue City utilities for nonpayment of
service charges, for tampering with the service, for violation of cross connection rules or regulations, or for any other reason that may be
detrimental to the City system. Refusing to permit such inspection shall be grounds for immediate discontinuance of reclaimed water service.
PART FOUR PAID IN FULL_______ PAYMENT PLAN______
PAYMENT PLAN TERMS: Total cost of $600.00 and with a $200.00 down payment, I hereby agree that with the outstanding amount due and payable is
$400.00 and further agree to make payments of $40.00 per month starting with the 1st utility bill and ending on the 10th bill after submitted/accepted
application. These payments will be added to the normal monthly utility bill as a recurring charge in the amount of $40.00.
I further understand that if I DO NOT complete the payment plan in full, the City shall be entitled to take all legal action permissible, including but not limited to,
delivering the underlying utility lien to county court for enforcement and/or forwarding this matter to a collection agency to secure payment.
I agree to the foregoing agreement to pay the balance of the reclaim connection.
Terms of Agreement Accepted: ___________________________________________________ Date______________
