HomeMy WebLinkAbout20190117 Eberlein Subdivision Water Service Agreement t66 4 City of J.
Saratoga � C
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Lake Avenue MAFIA' M 1ISSIONF i
ii: ' • 744. Saratoga Springs, New
York 12866 ,
it) 1.;'?`} 111 ' 6
• r . Phone 518-587-3550 ** Fax 518-587-2417
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NEW WATER SERVICE CONNECTION
AGREEMENT efc APPLICATION FORM
Geraldine M. Eb rl rn two LotSubdivision
,� Project Name (ifapplicable):
Property Owner's Name: � �. -
2 Ruggles Road 154.-1 -23. 1
Property Address: TaxMa
Size of Tap (check one below):
3ji"ID [7i'eater than 1"
A unit of water shall be defined as fourteen thousand (14,000) cubic feet
of water per year.
Contact the Water Dept at ext. 2502 for assistance with water
and meterspecifications before signing below.
use estimation
Number ol`Dwellings: - - �. � Estimated
Cubic ee Water per Year:
test on or before the BuildingInspector approval of the rough plumbing,To becompleted in full �thaut any contingencies or protest,
including the installation of the water meter, or at the time a ' the issuance of a tapping permit
and complete authority toexecutethis document and find and commit �
The undersigned represents tothe -� that theyhave full f'
Selo
developer to abide bythe City Water Ordinance. This agreement shall be binding on all of'the undersigned transferees.de p
will be del eyed to ail appropriate and necessarygovernmental eutitie .
The undersigned acknowledge,: that `copy of document
4151.0
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Authorized Signature:
Company Address:
Phone Ntber: ..�. -� � - -
' . Number: __ - date:
.1.1.1..*+1. i....m......-C-..•..-r 41.,..N .. . .......-
DepartmenL of Public Works Approval:
Date: _ ___ .�..