Y:\City Hall\Community Development\FORMS\PERMIT APPS & HANDOUTS\NSF HOME - Building Permit Package\2020 Building Requirement Revision\Water Service App_SH.doc Revised 12.13.19
Application is hereby made to the City of Spring Hill, Johnson/Miami County, Kansas, for a supply of water from the
municipal water main, to be used upon the premises of the applicant, described as follows:
Name of Owner Address Phone No.
Name of Contractor Address Phone No.
PROPERTY ADDRESS:
LOT NO: BLOCK NO: TYPE OF CONSTRUCTION: COMMERCIAL RESIDENTIAL
SUBDIVISION: PHASE/PLAT:
under the following terms and conditions:
1. Applicant agrees to install or have installed, by a licensed plumber, the water service connection between the
City’s water main and the water meter set. The City agrees to provide the meter setter, meter pit, ring, lid, water
meter, tapping saddle, corp. valve and all necessary fittings to install the meter set. The applicant is responsible
for the copper piping which shall be K Soft Copper. Services greater than two (2) inches shall be Class 200 PVC,
Yellowmine or ductile iron pipe, all joints shall be restrained. Services greater than two (2) inches shall be
addressed on a case by case basis.
2. Applicant agrees to furnish and lay the necessary pipes, fittings, and valves, and to make the necessary
connections between the meter and the place of consumption, in a skillful and workmanlike manner, and at no
expense to the City.
3. Applicant agrees to pay for the water taken from the City Main, such rates as shall be fixed by the City.
4. Applicant agrees that the City shall have the right to shut off the water supply to the applicant at any time, for
either or any of the following reasons: (1) for repairs; (2) for want of supply; (3) for non payment of bills when due;
(4) for fraudulent representation in the consumption of water or tampering with the meter used to measure water
supplied to the applicant; (5) for want of economy in the use of water; (6) for violation of any City Ordinance
relative to the use, sale, or consumption of water.
5. Applicant agrees to comply with all City Ordinances governing the sale, use, or consumption of water.
6. That no charge shall be made for water supplied inhabitants of said City of Spring Hill, prior to the date of
approval of the water supply of said City, for human consumption by the State Board of Health.
By signing this application, I understand and agree that I will be responsible for paying the monthly sewer
usage charges, in addition to the sewer system development fee, for the property address outlined above upon
the issuance of a Certificate of Occupancy (CO) or Temporary Certificate of Occupancy (TCO), until such time as
the new property owner has contacted the City of Spring Hill Utility Billing Dept. to apply for utility services.
These fees are in accordance with Resolution No. 2017-R-16, adopted by the Governing Body on August 24,
2017.
Signature (Applicant/Owner/Agent) Date
Printed Name (Applicant/Owner/Agent)
Community Development/Planning Dept.
401 N Madison St., Spring Hill, KS 66083
(913) 592-3657 ● (913) 592-5040 FAX
planning@springhillks.gov ●
The above applicant is hereby granted permission to proceed with construction of said sanitary sewer and connection as stated in said application subject to approval by the City
Inspector or his duly authorized agent.
Permit Authorized by: Date:
Water: Deferred or Non-Deferred (circle
one)
Permit Fee $__________________________
Master Permit No.______________________
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signature
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