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Revised: 11/8/2016 VILLAGE OF FAIR HAVEN WATER SERVICE CONNECTION APPLICATION This agreement signed this of (day) (month) (year) by phone (name of owner) (mailing address) is authorization by the Village of Fair Haven Water Department to serve the property hereinafter indicated, after the approval by the Village of Fair Haven Board of Trustees as indicated below. In consideration for this authorization, the following conditions are understood: Only surplus and potable water are to be made available to the consumer. The homeowner will install at their expense a curb valve shut off as specified by the water superintendent beyond the villages curb valve. All present rate schedules, rules and regulations and any amendments thereto which have been or may be made are to be adhered to by the consumer. (Copies of the current rates, rules and regulations are available at the Village Office). The costs of providing services such as but not restricted to those listed below: o Tapping the main o Installing service line, curb stop valve and curb box o Installing a meter pit, meter and needed the meter reading unit o Cost of crossing over or under a village, town, county, or state road for installation o Cost borne by applicant will be borne by the user, and such initial charge be paid before the start of service, unless other arrangements are approved by the Village Board of Trustees prior to the start of the work The service connection will be made at the convenience of the Water Department as near to the requested date for start or service as is practical. Water will not be turned on until all service connection charges are paid. This contract is nontransferable, and is subject to yearly review by the Board of Trustees of the Village of Fair Haven. Address where service connection is desired: Request submitted by: Date: Approved by motion: Date: (Mayor’s Signature) FOR THE BOARD OF TRUSTEES