Notice Of Consent To Turn On Village Water Supply
Village
of Fultonville
PO Box 337
Fultonville, NY 12072
Phone 518-853-3815
Fax 518-853-4813
Linda
Petterson-Law, Mayor Robyn
Rose, Deputy Mayor
ACCOUNT
#
Notice of Consent to TURN ON Village Water Supply
|
THERE
IS A $30.00 CHARGE FOR THIS SERVICE
This
document serves as notice to the interested parties of the Village of
Fultonville that I/we wish to be served with water from the municipal water
supply of the Village of Fultonville. Accordingly, a water meter reading will
be taken, if applicable, and a water bill issued for the amount of water used, based
on an actual meter reading, billed at the next regular billing cycle, of which
I/we agree to pay without penalty within 30 days of receipt of same. Water will
not be turned on until property is inspected by the Water Superintendent and a
Village approved water meter is installed. After 30 days a 10% penalty will be
applied as prescribed by the rules and regulation governing water usage that are
currently in effect. Sewer charges, if any, will continue according to the
sewer ordinance, even if no water is used. Upon failure to pay these charges
within the current fiscal year they will be relevied to the Village property
tax bill, _______(sbl#).
Signature
Name:
Property
Location:
Billing
Address: Phone
#:
*** For Office Use Only: Work Order # ***
Date
Notice Receive: Meter
Serial #
Water
Meter Reading: Date
Read:
Turn
on fee Paid: Billed: Bill Date:
This
certifies that water service has been turned on, with a functioning water meter
installed, as prescribed by the above notice on this date.
Date:
DPW
Superintendent
Entered
into BAS: Date By:
4/17/2018 2:15:10 PM