Form 1
STATE OF ILLINOIS )
) SS
COUNTY OF CHAMPAIGN )
PLUMBER’S AFFIDAVIT FOR PERMANENT SECOND WATER METER
The undersigned affirms that he or she is a duly licensed plumber with the State of Illinois with license number ____________________________. The undersigned also affirms that he or she is familiar with the village’s Chapter 51 and that he or she has installed a second water meter in compliance with said chapter at the following property:
__________________________________________________
address
__________________________________________________
owner
X_____________________________________
______________________________________
(Print Name)
Subscribed and sworn to before me this ____ day of __________________.
______________________________________
Notary Public
Form 2
SECOND WATER METER PERMIT APPLICATION
________________________________________________
Name
________________________________________________
Address
________________________________________________
Water Account Number
I hereby request a permit as follows:
___________________ A temporary second water meter ($75 deposit required, $40 fee each year)
___________________ A permanent second water meter ($20 fee due when billed or no sewer tax credit)
By submitting this permit application, I am requesting to be allowed to have a second water meter and understand that it is to be metered to monitor only water that is used for the watering of lawns and/or gardens and use in swimming pools. I have read Chapter 51 and understand it. I recognize that it is a privilege to be able to make use of this meter and understand that if I violate the chapter a fine of not less than $75 and not more than $750 may be made against me. I consent to audit, access to my property, and inspection by the village at its election to confirm my compliance with the chapter.
Dated this _________ day of _______________________.
The $40 fee and, if applicable, the $75 deposit are due up front with this application.