Fillable Residential Water and Sewer Application Service Information (City of Charlotte)

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Residential Water and Sewer Application Service Information (City of Charlotte)

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U.S.A. forms for City of Charlotte

BROWSE CITY OF CHARLOTTE (NC) FORMS

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Mail or deliver this application along with a check or money order to:
CHARLOTTE WATER
Customer Services
5100 Brookshire Boulevard
Charlotte, NC 28216
www.charlottewater.org (Service Connections)
Residential Water and Sewer Application
Service Information
First name
Last Name
MI
Company
Street Address
Apartment/Unit #
City State Zip Tax Parcel Number
Phone (On-site Contact)
Billing Information
First name
Last Name
MI
Company
Street Address
Apartment/Unit #
City State Zip Tax Parcel Number
Phone (Billing Contact)
Connection Size(s)
Domestic Water Sewer
Check the appropriate connection type Check the appropriate connection type
Size Size
☐ ¾ inch ☐4-inch
☐1 inch ☐1 ½ inch low pressure
☐Using Private Well ☐Using Private Septic System
☐Duplex/Triplex ☐Other
¾ inch is the common residential water service size
4 inch is the common residential sewer service size
Irrigation
Check the appropriate connection size:
☐ ¾ inch ☐Split connection ☐ Dedicated Connection ☐1 inch (dedicated connection only)
¾ inch is the common residential irrigation service size
For split irrigation requests: Is/will domestic meter box be located in concrete? ☐ Y ☐ N
All requests for irrigation service must be accompanied by a Backflow Prevention Service Application
Office Use Only
NCDOT Road: Y/N NCDOT Encroachment Required? Sewer Main Size:
Map # Side Cross Street
Water Main Size:
Premise #
Water: Short Side/ Long Side/ Side Street/ Ext Req.
Sewer: Short Side/ Long Side/ Side Street/ Ext Req.
Customer#
Water Inv.#
Water S/O #
Project # Sewer S/O #
Sewer Inv. #
Water S/O #
Sewer S/O #
Multi-Family:
Units:
Notes:
Cycle: Route:
**CUSTOMER SHALL INDICATE SERVICE LOCATION(S) WITH SUPPLIED FLAD OR OTHER MEANS OF MARKING UPON PAYMENT**
(Split irrigation not allowed when domestic is in concrete)
Sequence:_____
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Residential Water and Sewer Application Service Information (City of Charlotte)

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Completed 9 December 2021

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