RETURN TO SITE - Water Service App

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THE TORRINGTON WATER COMPANY WATER SERVICE AVAILABILITY INQUIRY AND APPLICATION FOR WATER SERVICE Date: _______________ Address of Property:_________________________________________ If for one single family house describe location – on _________ side of _____________ street between existing houses # ____ and #_______. If for anything other than one single family house provide copy of Assessors map or preliminary site plan. Property Owner’s Name: Mailing Address: Telephone Number: Service to be provided for: ______One single family home ______Condominiums ______Industrial building

______One duplex house ______Commercial building ______Private Fire Service

Signature of owner: ____________________________________ Printed Name: ____________________________________ Date:______________________

FOR OFFICE USE ONLY Does Main Exist at location _______yes size of main ________ _______no – extension required Static Pressure at site: ________ Account Number:_________________ Meter Size: _________________ Service Size: _________________

Private Fire Acct Number:_____________ Backflow Acct Number: _____________

Application Approved by: _____________________ Date: _______________ Company reply of availability or approval of service _________________ Comments: