Application For Water Or Sewer Tap Template
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1Prepaid Tap:
Yes
No
TOWN OF RIDGWAY
APPLICATION FOR WATER OR SEWER TAP
__________________
Application Date
APPLICATION
Application is hereby made by ______________________________________________ for a permit to tap the
(print name)
Town
water or
sewer system at ____________________________________________________ to serve
(physical address)
(mailing address)
Lot No. __________ in Block No. ________ of ___________________________________________________
(name of subdivision, if any)
Or, other described locations: _________________________________________________________________________.
The property to be served is owned by: _________________________________________________________________.
The applicant understands that this permit when issued constitutes an agreement between the Town and the property
owner under the following terms and conditions.
A. Excavation for the above named tap may be authorized in the above described street or alley provided the grantee
applies for and receives an approved encroachment permit for the work, and pays applicable fees to the Town. All
work shall be completed in accordance with the executed encroachment permit.
B. Inspection and approval of all taps and piping installations shall take place prior to backfill. Inspections will be made
within 48 hours from the time of request after completion of the tap, except for Saturdays, Sundays, and holidays.
C. The grantee of this permit is responsible (at their expense) for complying with Manual of Uniform Traffic Control and
for furnishing all lights, flares, barricades, walkways, covers and other safety devices that are required by Town and
State law to properly protect the public during the progress of all work under this permit.
D. The minimum specification for materials to be used, the method of installation and all conditions of use for all
enlargements or attachments to the Town owned utility systems shall be consistent with Chapter 9 of the Ridgway
Municipal Code, the excavation and encroachment permit, and the Town’s standards and typical drawings.
E. Applications for non residential sewer taps shall be accompanied by a wastewater questionnaire. Additional
conditions of service may be applied to non residential sewer taps.
F. Absent prior Town approval, no excavation shall occur in Town streets, alley and other rights of way between
th
th
November 15
and March 15
in any year. (Resolution 09‐11)
G. Owner agrees to comply with Town regulations for utility service and payment of applicable fees.
_________________________________________
Property Owner Signature
PERMIT DETAIL
(TOWN USE ONLY)
Type of Service:
Residence
Business ‐‐ Type of business: _____________________________________________
Service Status:
New
Existing
Size of Water Tap:
3/4”
1”
1.5”
2”
3”
4”
6”
Other ___________
Size of Sewer Tap:
4”
Other __________
Tap Fee
$ ___________
Installation/Meter/Can fee
$ ___________
PRV Charge
$ ___________
Escalator Fee
$ ___________ (for pre‐paid tap)
Other
$ ___________
Total fees Due:
$ __________ Date paid __________
Cash
Check # ________
Comments:
Approved for the Town by: ______________________________
Date: __________________
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