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2. Today's Date:*
   Today's Date:
3. Contact Phone #:*
5. Customer Name:*
6. Alternate Phone:
8. Customer Address:*
10. Application for:*

    1. Water - please specify size in "Size of Tap" box. Example - 3/4" or larger
    2. Sewer - please specify size in "Size of Tap" box: Example - 4" or 6"
    3. Lawn Sprinkler - please specify size in "Size of Tap" box: Example - 3/4" or 1"
    4. Fire Sprinkler - please specify in size in "Size of Tap" box: Example - 6" or 4"
    5. Relocate Service
11. Size of Tap:*
13. TAP LOCATION ADDRESS or BCAD Property ID#:*
14. Plumber:
16. Preferred depth of sewer tap at property line.
18. Notes or Special Instructions:
20. Application Fee for Initiation

    Applicants must call the Development Services Department at 325-646-5775 to pay the $25 deposit fee to initiate the utility investigation.

24. FOR OFFICIAL USE ONLY
26. Legal Description:
28. Fees

    Application Fee: ______________________$25.00

    Water Tapping Fee: ___________________________

    Sewer Tapping Fee: ___________________________

    Lawn Sprinkler Tapping Fee: __________________

    Fire Sprinkler Tapping Fee: ___________________

    Relocate Service Fee: _________________________

    Total: (Valid 15 days) __________________________

    Date Paid: _____________________________________

    
    

    Received by: _____________________________________

    Utility Dept.: _____________________________________

    Public Works Director: __________________________

    Plumbing Inspector: _____________________________

    Billing Office: _____________________________________

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

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