Application For Water Service Connection Form
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1CITY OF BIG RAPIDS
UTILITIES DEPARTMENT
WATER DIVISION
APPLICATION FOR WATER SERVICE CONNECTION
Date _____________________________________
ADDRESS OF SERVICE
Name of Applicant
Address of Applicant
Phone Number
Name of person to be invoiced
Address of person to be invoiced
Size of Service: *1" !
1 1/2" !
2" !
4" !
other
5/8" ! 3/4" !
1" !
1 1/2" !
2" !
3" !
Size of Meter:
other
Replacement Service !"""New Service !
*NOTE: Standard house size
All water service connection pipe must be Type “K” copper water service pipe unless otherwise specified and
approved by the City Water Division.
Property Zoning: Residential !
Commercial !
Industrial !
Yes !
No !
A.
Will property served have a steam or hot water boiler:
Yes !
No !
B.
Will property served have an underground sprinkler system:
Yes !
No !
C.
Has Mecosta County Plumbing Permit been obtained:
If answer to either A or B is “Yes”, a “Backflow Preventor” is required as a condition of issuing of a Water
Service Connection Permit. If application is for an industry, a “Backflow Preventor” is required.
Name of Contractor installing service:
Phone #
Address of Contractor installing service:
Applicant Signature: _______________________________________ Date___________________________
Utilities Approval Signature:_________________________________ Date___________________________
Public Services Approval Signature:
__________________________________________________________
Final Inspection by ______________________________ Date ___________________ Time
________________
!"
!"""Type/Model _____________________
Backflow Preventer installed per permit Yes
No
NOTICE:
1.
Property owner is responsible for all cost for new service
2.
Property owner shall pay fee as set forth in Water Ordinance if this is for a water
service replacement.
3.
No work shall commence until a Water Service Connection Permit is issued.
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Parent category: Business