(A) Application for culinary water connection. Any person, other than a subdivider or developer seeking multiple connections, who desires or is required to secure a new connection to the culinary system, shall file with the Water Department for each such connection, a written and signed connection application in substantially the following form:
TOWN OF GOSHEN
APPLICATION FOR CULINARY WATER CONNECTION TO THE
TOWN OF GOSHEN, UTAH:
I hereby apply to the municipality of the Town of Goshen (“Town”) for permission to connect my premises at ________________________________ with the Town of Goshen culinary water system and hereby agree as follows:
1. The Town shall make the requested connection from its water main to and including the distance and up to my property line. I agree to pay the Town such connection fees as may be fixed by the governing body by resolution, ordinance order of the Town, including also a deposit security charge, if so provided.
2. The work of extending the water connection from the nearest point to which the Town installs its main to the place at which the water is to be used shall be my responsibility and shall be performed at my sole cost.
3. The location of the service, whether on my premises or at some point near my premises, may be decided solely by the Town.
4. I understand the Town reserves the right to the culinary and water system upon my premises to be inspected by the town and I will cause the same to be collected and improved at my own expense to meet the requirements of the Town or of any other governmental agency having jurisdiction to regulated the water system within the Town.
5. I will be bound by the rules, regulations, resolutions or ordinances enacted now or hereafter by applicable to the Town applicable to the Town’s culinary water system.
6. The main purpose for which the water connection will be used is for culinary use.
7. The Town shall have free access to the lines and services installed under this agreement and, at reasonable times, through my property, if necessary.
8. Expressly grant a lien upon the premises above described so that any delinquent water billings must be paid before any services can be provided to any subsequent user or water at these premises. This lien shall bind any subsequent owner, possessor, occupant, tenant, landlord or person or entity using or requesting use of Town water at these premises.
DATED THIS _____________ day of _____________________, 20______.
_______________________________
Applicant
(B) Application for water connection by subdivider. Whenever a subdivider or developer desires or is required to install water connections and extensions for a subdivision or development, the subdivider or developer shall enter into a written extension agreement which shall constitute an application for permission to make the extensions and connections and an agreement specifying the terms and conditions under which the water extensions and connections shall be made and the payments that shall be required.
(C) Application for water service. Any person who desires or is required to secure water services when such service is available from the town water system, shall file with the Water Department a written application and agreement for the service which shall be in substantially the following form:
The Town of Goshen, a Municipal Corporation of the State of Utah
and; ______________________ hereafter Customer
and; ______________________ hereafter Co-Signer
Do agree as follows:
1. The Town of Goshen will provide the following services at the address indicated on the New Residential Customer Water and Garbage. Set-Up Form printed on the reverse side of this document which is hereby incorporated by reference.
Culinary Water
Garbage Pickup
The service shall be provided in accordance with State Law and municipal ordinances and resolutions as requested on the Setup form at tares established by ordinance or resolution of the Town of Goshen Town Council, provided that the Town of Goshen shall not be responsible for failure to deliver services by reason of strikes, accidents, acts of God, weather conditions, natural disasters, whether declared or undeclared, State or other Governmental regulation, or any other act or contingency beyond the Town’s control.
2. Customer shall pay such fees as shall be established by the Town Council and shall further be subject to termination of services upon non-payment or failure to comply with rules, regulations, ordinances or laws as established by the Town Council. Customer acknowledges and agrees to pay charges for the water deposit and connection fee, minimum water charges, garbage pick-up, even in the event that the premises are vacant for extended periods of time. Customer may eliminate minimum water charges and garbage charges only upon requesting the Town of Goshen to terminate service. In such event, Customer agrees to pay a reconnection fee to restore water service.
3. The Town of Goshen requires free unobstructed access to water meters at all times.
4. Co-Signer does hereby agree and is hereby bound and is equally liable with Customer to pay the Town of Goshen any amounts billed pursuant to this contract.
5. In the event Customer defaults in payment, Co-Signer agrees to give the Town of Goshen the right to attach any delinquent amount to Co-Signer’s personal utility account. Co-Signer’s utility service will be subject to disconnection if acceptable arrangements are not made with The Town of Goshen to pay off said delinquent amount.
6. Customer and Co-Signer agree to pay reasonable attorney fees and a $50.00 reconnection fee in the event collection becomes necessary. Customer agrees if this location is a commercial establishment, the person(s) signing this contract is (are) held personally liable for charges.
7. Customer and Co-Signer, if any, hereby warrant and affirm that the information provided on the New Residential Water and Garbage Set-Up Form on the reverse side of this sheet is true and correct to the best of their knowledge.
DATED this _____ day of ___________, 20___.
CUSTOMER SIGNATURE CO-SIGNER SIGNATURE____________________
PRINT NAME OF PERSON SIGNING: ______________________
PRINT NAME PERSON CO-SIGNING:_______________________
NEW RESIDENTIAL CUSTOMER WATER & GARBAGE SET UP
Application Date: _______________________________________________________
New Service Date: ______________________________________________________
Application Information
Please Check: _______ Owner ________ Renter ________ Mobile Home
________ Land Lord ________ Realtor
Customer Name: _____________________ SSN: ________________ DOB: _________
Address of Service: ______________________________________________________________ ________________________________________________________________
Mailing address: __________________________________________________________________
City: _______________ State: __________________ Zip:_________
Customer’s Employer: _______________________________________________________________
Home Telephone: ______________________________
Work Telephone: ______________________________
Cellular Telephone: __________________________
Nearest Relative Not Living with You: __________________________________
__________________________________
__________________________________
__________________________________
Have you or your spouse ever had an account with the Town of Goshen?
______Yes ____No Under What Name? _______________________________
CUSTOMER SIGNATURE: ____________________________ DATE: ______________
CO-SIGNER SIGNATURE: ____________________________ DATE: _______________
FOR OFFICE USE ONLY: Utility Account No:________________________________________
DEPOSIT:_____________________ DATE:_____________________
(D) Non-owner applicant; agreement of owner. Applications for water service made by the tenant of any owner must, in addition to the above requirements, be guaranteed by an agreement signed by the owner of the premises, or his or her duly authorized agent, in substantially the following form:
In consideration of the acceptance of the application for water service submitted by (tenant), I or we will pay for all charges, fees and costs at (premises) in case such tenant or occupant shall fail to pay for the same according to the ordinances, rules and regulations or resolutions enacted by the Town.”
I expressly grant a lien upon the premises above described so that any delinquent water billings must be paid before any services can be provided to any subsequent user of water at these premises. This lien shall bind any subsequent owner, possessor, occupant, tenant, landlord or person or entity using or requesting use of Town water at these premises.
DATED THIS _____________ day of _____________________, 20______.
_______________________________
(Ord. 2004-29, passed - -2004)