Fillable Water Restoration Form Fillable (City of Meriden (CT))

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Water Restoration Form Fillable (City of Meriden (CT))

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CITY OF MERIDEN
DEPARTMENT OF PUBLIC UTILITIES
117 Parker Avenue Dennis Waz
Meriden, Ct 06450 Director of Public Utilities
(203) 630-4256
FAX (203) 630-4285
MERIDEN WATER DIVISION
WATER RESTORATION FORM
Agreement to restore water without owner present
Name: _____________________________________
Address: _____________________________________
_____________________________________
Telephone: _____________________________________
By signing this agreement, I hereby certify that:
*I am the owner of the above property and am authorized to sign this agreement;
____________ (Owner’s initials)
*Any and all open faucets, valves & water fixtures both inside and outside have been
closed and turned to the “off position”; _____________ (Owner’s initials)
*I have inspected all faucets, valves & water fixtures, both inside & outside and verify
that it will be safe for the Meriden Water Division to restore water service;
____________ (Owner’s initials)
*I agree that the Meriden Water Division, City of Meriden has permission to restore
water to the above property without my onsite presence. ___________
(Owner’s initials)
*I agree to hold harmless the Meriden Water Division & City of Meriden from any
liability for any damage whatsoever incurred during water service restoration;
________________ (Owner’s initials)
________________________
Signature
________________________
Date
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Water Restoration Form Fillable (City of Meriden (CT))

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Completed 13 July 2020

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