Water & Sewerage Support – New Connections Form

Step 1 of 5 - Connection Information

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APPLICATION AND AGREEMENT FOR WATER SUPPLY/AND/OR CONNECTION TO SEWERS
By this application, I/we, the owner(s) or agents of the owner(s), hereby contract with the Water and Sewerage Corporation, hereinafter called the Corporation, to supply the following services at the service address shown below. We further agree to abide by the laws, regulations and/or policies governing the Corporation. It is noted that upon failure to make payments on this account within six (6) months or more, the Corporation reserves the right to apply my service deposit to my outstanding balance, and refund any credits due to me resulting there from, should the assigned account be finalled and closed.
- Supply Water For Domestic/Commercial Purposes
- Connect Sanitary Fixtures And Drainage To The Sewer System
THE ADDRESS OF THE PREMISES TO BE CONNECTED IS AS FOLLOWS:
Lot No
House/Bldg No
Apt/Unit No
Street
Subdivison
Permit No
Phone
Other Directions
Premises Are:
- Under construction
- Under renovation
- Ready for occupancy
- Occupied
If Unoccupied, Projected Occupancy Date
MM slash DD slash YYYY

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PREMISES WILL BE USED FOR
- Single Family Dwelling and number of bathrooms
- Apartments with total number of units
and total number of bathrooms
- Hotel/guest house with total number of rooms
and number of clubs/restaurants/bar
- Restaurant / club / bar with total number of seats
and number of bathrooms
- School with total number of students
- Laundry with total number of machines
- Commercial building with total number of occupants
and number of bathrooms
- Other (specify)

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THE NUMBER OF FIXTURES INSTALLED/TO BE INSTALLED AT THESE PREMISES IS AS FOLLOWS:
FIXTURE TYPE
NUMBER
FIXTURE TYPE
NUMBER
Bathtub with/without shower head
Bidet
Shower, stall, domestic
Dishwasher, domestic
Dishwasher, commercial
Automatic clothes,washer
Lavatory with small pipe plug outlet
Lavatory with large pipe plug outlet
Lavatory (barber, beauty parlor)
Laundry tray (l or 2 compartments)
Kitchen, sink, domestic
Kitchen, sink, domestic with food grinder
Service sink, combination trap standard
Janitor service sink, trap ordinary
Wash sink (circular or multiple) each set of faucets
Urinal
Water closet, tank operated
Water closet, valve operated
Floor drains

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- Owner/Agent
- Tenant
Applicant Surname
First Name
Middle Name
Nat'linsurance#
Passport#
P.O.Box#
Email
Mortgage Holder/Bank Reference#
Branch#
CO-Applicant’s Surname
First Name
Middle Name
Nat'linsurance#
Passport#
P.O.Box#
Workplace#
Workphone#
Homephone#
Additional Contact Person (required if there Is no co-applicant)
Surname
First Name
Middle Name
Workplace#
Workphone#
Homephone#
I/we hereby affirm that all information provided is, to the best of our knowledge, both true and correct and authorize you to contact the reference (s) cited above for further information to support this application.
Date
MM slash DD slash YYYY
Applicant's Signature
Co-Applicant's Signature
Company Director (1)
Company Director (2)
Trustee (1)
Trustee (2)

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TENANTS MAY APPLY UPON SUBMITTING WRITTEN AUTHORIZATION FROM THE OWNER – FORM CS009(a). RECEIPTS ARE YOUR EVIDENCE OF PAYMENT. A SERVICE ORDER FOR INSTALLATION OF SERVICE WILL NOT BE ISSUED UNTIL PAYMENT IS RECEIVED.

Applications are to be submitted by the owner(s) or his/her agent, or a tenant in whose name the lease or rent receipt appears. If acting as agent, the application should be accompanied with a notarized power of attorney or written authorization in their favor from the owner(s). The owner(s)/tenant(s) are required to bring in proof of identification, i.e. valid PASSPORT (s), and NATIONAL INSURANCE CARD (s).

In case of joint ownership, all owners e.g. husband and wife or their authorized agent must sign.

In case of tenants, the application must be accompanied by copy of the lease and/or proof of payment of rents or deposit.

In case of Limited Company, the application must be signed by two or more directors of the Company.

In case of a church, not for profit or similar association, at least two trustees must sign.

I/we agree to pay all lawful charges in respect of installation of the water and/or sewer service connection(s) including such road reinstatement charges as may be assessed by the Corporation. I/we further agree to pay the appropriate service deposit, and such additional deposits/charges as may be required at a later date.

I/we agree to comply, in full, to all Rules and Regulations in force, governing water supply and waste water sanitation, and to any regulations made hereafter by the Water and Sewerage Corporation. To this end, I/we agree to employ a Licensed Plumber, and submit a certificate from him to the effect that rules and regulations governing house sanitation have been complied with, before permission to connect to the street sewer is granted. I/we further agree, in the event the water pipework fittings, equipment, appliances and the like on the property are not fully in accordance with the above mentioned Regulations, to have all necessary repairs, replacements, medications and alternations carried out by a Licensed Plumber.

3.	I/we enclose herewith a diagram showing the plumber’s recommended location of water meter and/or sanitary drainage line to the street sewer for consideration and approval by the Corporation.

4.	In relation to 2 above, I/we agree to maintain such pipe work, fitting, equipment, appliances and the like, in good and fully satisfactory order and condition and in full compliance with all Regulations in force.

I/we undertake to pay the Corporation for all water registered by the installed meter and subsequent meter(s) as may be connected to the supply line and/or such minimum charges as may be fixed for supply and/or such charges that may be assigned to sanitary fixtures at the rates and charges now fixed or which may hereafter be fixed by the Corporation.

I/we fully understand and agree that the Corporation is not and will not be in any way responsible for any defect, waste, misuse or pollution of water after it has passed through the meter and I/WE further agree to accept full liability for all quantities of water registered by the meter regardless of tenancy of premises.

7.	I/we affirm that as owner(s)/authorized tenants of the property, we accept responsibility for all matters associated with the establishment of the account.

8.	Allow 48 hours for the application to be processed and for Customer Services staff to notify you of the applicable charges.

9.	Allow an additional ten (10) workings days from receipt of payment for your connection(s) to be made.

10.	Cash, certified cheque or credit card payments accepted. Personal cheques are accepted from customers with existing accounts in good credit standing only.

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Water & Sewerage Support – New Connections Form

Step 1 of 5 - Connection Information

APPLICATION AND AGREEMENT FOR WATER SUPPLY/AND/OR CONNECTION TO SEWERS

PREMISES WILL BE USED FOR

THE NUMBER OF FIXTURES INSTALLED/TO BE INSTALLED AT THESE PREMISES IS AS FOLLOWS:

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