The undersigned, representing himself or herself as owner of the property located at ___________________________________________________________, hereby makes application for connection to the Water System of the village for the property, and in consideration of the furnishing of the service covenants and agrees as follows:
1. I agree to abide by all rules and regulations as specified in and by the ordinances of the village now in effect or enacted and passed from time to time providing for the regulation of service furnished by the village, it is further acknowledged and agreed that the undersigned, his or her heirs, executors, administrators, successors and assigns shall pay all charges for connection fees and water usage which shall become due as the result of the connecting of the water mains and the furnishing of water service to the above property, and that all such charges and fees for water service rendered to the property, together with penalties, if any, and the costs of collection are to be considered and become a charge against the property, the then so created to be enforced in accordance with the ordinances of the village.
2. All bills for the aforesaid charges are payable on or before the due date following the receipt of the bill and. if not paid, are subject to a 10% penalty.
3. Each and all of the agreements and covenants herein contained shall run with the real estate above described whose present owner is signatory to this application.
4. I understand that after making this application, I am to await installation permit and instructions therewith.
5. SERVICE CONNECTION FEE: $ ____ is enclosed herewith, payable to the village.
6. Permission is hereby granted to the village and its authorized representatives at any reasonable time to enter the premises of the applicant and any portion thereof for the purposes of inspecting all connections appurtenant to the Water System.
CONNECTION MUST BE INSPECTED BEFORE BACKFILLING:
SIGNATURE: __________________________ _______________________________________
__________________________________________________
(STREET NUMBER AND NAME OF STREET)
__________________________________________________
(VILLAGE, STATE AND ZIP CODE)
_________________________________________________
(TELEPHONE NUMBER) (DATE)
_____________________________________________________________________________________
(
Do not fill in the MAIL BILLS TO: (________________________________________
spaces to the right (NAME)
if the information (________________________________________
is the same as the STREET NUMBER AND NAME OF STREET
applicant above. (
(_______________________________________
VILLAGE, STATE AND ZIP CODE