HomeMy WebLinkAbout20180432 18.031 153SouthBWay_WATER SERVICE FORMCity of Saratoga Springs
OFFICE OF PUBLIC WORKS
5 Lake Avenue
Saratoga Springs, New York 12866
Phone 518-587-3550 ** Fax 518-587-2417
www.saratoga-springs.org
NEW WATER SERVICE CONNECTION
AGREEMENT & APPLICATION FORM
KCG Development
Property Owner's Name:
153 South Broadway
Property Address:
Size of Tap (check one below):
3/4 1"
110
Number of Dwellings:
A -110NY J. SCIRCccO
COMMISSIONER.
TIMOTHY 3• COGAN
DEPUTY COMMISSIONER
Project Name (if applicable) 153 S. Broadway
Tax Map#: 178.27-1-22 thru 29
Treater than 1"
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
use estimation and meter specifications before signing below.
Estimated Cubic Feet of Water per Year: 1,489,174
To be completed in full without any contingencies or protest, on or before the Building Inspector approval of the rough plumbing,
including the installation of the water meter, or at the time of the issuance of a tapping permit.
The undersigned represents to the City that they have full and complete authority to execute this document and find and commit the
developer to abide by the City Water Ordinance. This agreement shall be binding on all of the undersigned transferees.
The undersigned acknowledges th
Authorized Signa
Company Address:
ocument will be delivered to all appropriate and necessary governmental entities.
Company Name: KCG Development
55"N_ Meri• = . St. Suiw , Carmel, IN 46032
Phone Number: 850-559-8606
Fax Number: Date:
Department of Public Works Approval: Date: