Residential Water Service Application

2. Customer Name(First & Last)*

3. Spouse Name(First & Last)

5. Please note:
   <b>Water service connection can only be accommodated on weekdays. The City is unable to start water service on weekends or holidays.</b>

   Water service connection can only be accommodated on weekdays. The City is unable to start water service on weekends or holidays.

6. Date to start service*
   Date to start service

8. Service Address*

10. Mailing Address*

12. Zip Code*

13. Home Telephone*

15. How to receive your bill

    1. To receive your water bill by email please check

16. Enter your email address

18. Please indicate if you are*
    -- Select One --BuyingExisting Property OwnerLeasingVacant (for lease)Vacant (for sale)

19. Closing Date
    Closing Date

21. Former Address*

23. Customer's Employer*

24. Phone Number*

26. Spouse's Employer

27. Phone Number

29. Information Confidentiality

    1. I request that my personal utility account information be kept confidential

31. SERVICE WILL NOT BE INITATED WITHOUT CONCURRENCE OF THE FOLLOWING:
    The City of Sugar Land is responsible for protecting the drinking water supply from contamination or pollution, which could result from improper plumbing practices. The purpose of this service agreement is to notify each customer of the plumbing restrictions, which are in place to provide this protection. Each customer must sign this agreement before the City of Sugar Land will begin service. In addition, when services to an existing connection has been suspended or terminated, the water system will not re-establish service unless we have a signed copy of this agreement.

    The City of Sugar Land is responsible for protecting the drinking water supply from contamination or pollution, which could result from improper plumbing practices. The purpose of this service agreement is to notify each customer of the plumbing restrictions, which are in place to provide this protection. Each customer must sign this agreement before the City of Sugar Land will begin service. In addition, when services to an existing connection has been suspended or terminated, the water system will not re-establish service unless we have a signed copy of this agreement.

33. RESTRICTIONS
    The following unacceptable practices are prohibited by State regulations: <ul> <li>No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate back flow prevention device. <li>No cross connection between the public drinking water supply and a private water system is permitted. <li>No connection that allows water to be returned to the public drinking water supply is permitted. <li>No pipe or pipe fitting that contains more than 8.0 percent lead may be used for the installation or repair of plumbing at any connection that provides water for human use. <li>No solder or flux, which contains more than 0.2 percent lead, can be used for the installation or repair of plumbing at any connection which provides water for human use.</ul>

    The following unacceptable practices are prohibited by State regulations:

    • No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate back flow prevention device.
    • No cross connection between the public drinking water supply and a private water system is permitted.
    • No connection that allows water to be returned to the public drinking water supply is permitted.
    • No pipe or pipe fitting that contains more than 8.0 percent lead may be used for the installation or repair of plumbing at any connection that provides water for human use.
    • No solder or flux, which contains more than 0.2 percent lead, can be used for the installation or repair of plumbing at any connection which provides water for human use.

35. SERVICE AGREEMENT
    The following are the terms of the service agreement between the City of Sugar Land and the Customer. <ul> <li>The City of Sugar Land will maintain a copy of this agreement as long as the customer and/or the premises are connected to the water system. <li>The customer shall allow his property to be inspected for possible cross-connection and other potential contamination hazards. These inspections shall be conducted by the City of Sugar Land or its designated agent prior to initiating new water service; when there is a reason to believe that cross connections or other potential contamination hazards exist; or after any major changes to the private plumbing facilities. The inspections shall be conducted during the City of Sugar Land’s normal business hours. <li>The City of Sugar Land shall notify the customer in writing of any cross-connection or other potential contamination hazard, which has been identified during the initial inspection or the periodic re-inspection. <li>The customer shall immediately correct any possible cross-connection or other potential contamination hazards on his/her premises. <li>The customer shall at his/her expense, properly install, test, and maintain any backflow prevention device required by the City of Sugar Land. Copies of all testing and maintenance records shall be provided to the City of Sugar Land. </ul>

    The following are the terms of the service agreement between the City of Sugar Land and the Customer.

    • The City of Sugar Land will maintain a copy of this agreement as long as the customer and/or the premises are connected to the water system.
    • The customer shall allow his property to be inspected for possible cross-connection and other potential contamination hazards. These inspections shall be conducted by the City of Sugar Land or its designated agent prior to initiating new water service; when there is a reason to believe that cross connections or other potential contamination hazards exist; or after any major changes to the private plumbing facilities. The inspections shall be conducted during the City of Sugar Land’s normal business hours.
    • The City of Sugar Land shall notify the customer in writing of any cross-connection or other potential contamination hazard, which has been identified during the initial inspection or the periodic re-inspection.
    • The customer shall immediately correct any possible cross-connection or other potential contamination hazards on his/her premises.
    • The customer shall at his/her expense, properly install, test, and maintain any backflow prevention device required by the City of Sugar Land. Copies of all testing and maintenance records shall be provided to the City of Sugar Land.

37. ENFORCEMENT
    If the customer fails to comply with the terms of the service agreement, the City of Sugar Land shall, at its option, terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection.

    If the customer fails to comply with the terms of the service agreement, the City of Sugar Land shall, at its option, terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection.

41.  
    I have read and agree to the terms listed in the above service agreement between myself and the City of Sugar Land.

    I have read and agree to the terms listed in the above service agreement between myself and the City of Sugar Land.

43. Acknowledgement*

    1. I understand and agree

45.  
    I understand that a $50 deposit will be billed to my account unless a letter of reference is provided at the time of application. Letter of reference must be from another utility company and indicate no outstanding balance and no disconnections for non-payment during the last 12 consecutive billing cycles. The letter of reference may be faxed to 281-275-2769 within two weeks of applying for service. Please include on the letter of reference the new service address. I understand that if water service is discontinued for non-payment, additional deposits as well as delinquency fees will be assessed prior to service restoration.*

    I understand that a $50 deposit will be billed to my account unless a letter of reference is provided at the time of application. Letter of reference must be from another utility company and indicate no outstanding balance and no disconnections for non-payment during the last 12 consecutive billing cycles. The letter of reference may be faxed to 281-275-2769 within two weeks of applying for service. Please include on the letter of reference the new service address. I understand that if water service is discontinued for non-payment, additional deposits as well as delinquency fees will be assessed prior to service restoration.*

47. Acknowledgement*

    1. I understand and agree

49.  
    I understand that the City will begin water service outside the building or buildings to be served. I understand that the City will not have access to any building served and will not determine if there are any open faucets or water system leaks inside the building. If there are any open faucets or water system leaks that cause damage to the property, I agree not to hold the City responsible for any damages arising there from.

    I understand that the City will begin water service outside the building or buildings to be served. I understand that the City will not have access to any building served and will not determine if there are any open faucets or water system leaks inside the building. If there are any open faucets or water system leaks that cause damage to the property, I agree not to hold the City responsible for any damages arising there from.

51. Acknowledgement*

    1. I understand and agree

53.  
    I understand that the City requires a one working day notice to connect service. If service is required on the date of application, a $25 service initiation fee will be charged to my account.

    I understand that the City requires a one working day notice to connect service. If service is required on the date of application, a $25 service initiation fee will be charged to my account.

55. Acknowledgement*

    1. I understand and agree

57.  
    I understand that the City will not initiate service if the meter clearly indicates that water is running. There is a $10 charge for each subsequent trip to initiate service.

    I understand that the City will not initiate service if the meter clearly indicates that water is running. There is a $10 charge for each subsequent trip to initiate service.

59. Acknowledgement*

    1. I understand and agree

61.  
    I understand that residents receive garbage collection twice per week, recycling collection once per week, green waste collection once per week, and bulky waste collection once per month. Each household is provided with a 95-gallon garbage cart and a 65-gallon recycling cart, unless a different size is requested. To schedule the delivery of your garbage and recycle carts or to report service issues please contact Republic Services at 713-726-7307.

    I understand that residents receive garbage collection twice per week, recycling collection once per week, green waste collection once per week, and bulky waste collection once per month. Each household is provided with a 95-gallon garbage cart and a 65-gallon recycling cart, unless a different size is requested. To schedule the delivery of your garbage and recycle carts or to report service issues please contact Republic Services at 713-726-7307.

63. Acknowledgement*

    1. I understand and agree

Leave This Blank:


64. 1. Receive email copy
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field