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DATE: CITY & COUNTY OF BUTTE-SILVER BOW Department of Public Works WATER UTILITY DIVISION P.O. Box 667 Butte, Montana 59703-0667 NOTICE OF OCCUPANCY PREMISE NUMBER: _ OWNERS: PLEASE COMPLETE THIS FORM BEFORE RETURNING. Written notice is hereby given instructing the Water Division to collect water charges from _ (TENANT NAME) (TENANT PHONE#) as of for the property at (DATE)* (ADDRESS) *(The effective date cannot go back more than 30 days.) I understand the Water Utility Division will not be allowed to collect from this tenant without my written permission, and when this tenant cancels service, I will be responsible for the bill until the water has been turned off at the curb by the Water Utility Division or another Notice of Occupancy has been submitted. Per city ordinance #431, it is the owner's responsibility to maintain the curb box and make it accessible to the water division. Therefore, if at any time we find the curb box inoperable, or we are unable to tum the water off at the curb for any reason, the water bill will be taken out of the tenants name and the owner will then be responsible for the water bill until the curb box is accessible and operable. Property Owner (Please sign) Mailing Address Phone Number NOTE: Ten ants must come to the office to sign for s e rvice. (124 W. Granite Stre et• [PHONE REDACTED]) CUSTOMERS WHO HAVE NOT HAD SERVICE WITH BUTTE SILVER BOW WATER DIVISION IN THE LA ST 12 MONTHS OR HAVE BEEN DELINQUENT, WILL BE REQUIRED TO PAY A DEPOSIT. Date