CITY OF ELLSWORTH WATER DEPARTMENT
1 City Hall Plaza ▪ Ellsworth, ME 04605-1942
Phone (207) 667-8632 ▪ Fax (207) 667-4908
www.ellsworthmaine.gov
WATER DEPARTMENT BILLING ADDRESS UPDATE FORM
Customer Name_________________________________________________________________
Service Address__________________________________________________________________ OWNER
New Mailing Address______________________________________________________________ TENANT
Telephone #_____________________________________________________________________
Email Address____________________________________________________________________
PLEASE SELECT PREFERRED METHOD FOR BILLING DOCUMENTS:
PAPER EMAIL BOTH
Signature________________________________ Date___________________
Printed Name________________________________
THE OWNER/CUSTOMER FURTHER AGREES TO THE TERMS AND CONDITIONS AS FOLLOWS:
That the department by its representatives, shall have the right to enter the premises of the Applicant at a reasonable time for the purpose of making such inspections as it may
deem necessary, and it shall have the right to attach any testing device or use any means it may elect to ascertain the condition of the pipe and appurtenances and the uses made of same.
That the extent of the rights of the applicant under this Application is receive, such supply of water as shall then be available and no other or greater.
That the Applicant agrees that the department shall not be considered in any manner an insurer of property or persons, or to have undertaken to extinguish fire or to protect
any persons or property against loss or damage by fire, or otherwise and that it shall be free and exempt from any and all claims for damages on account of any injury to property or persons by
cause whatsoever. That the rights and obligations of the applicant hereunder shall be further subject at all times to the rates, rules, and regulations of the Department on file with the Maine
Public Utilities Commissions, that now exists or which may hereafter be adopted of file.
NOTE: A BACKFLOW PREVENTER WILL BE REQUIRED AT THE SERVICE ENTRANCE. RESIDENTIAL BACKFLOW PREVENTERS UP
THROUGH 1” IN DIAMETER DO NOT NORMALLY REQUIRE A PERMIT
