Stub-In Permit Form - Denver Water
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1Stub-in Permit
1600 W 12th Ave. ▪ Denver, CO 80204
303-628-6100 ▪
Owner/Agent Name (print):__________________________________________________ Phone: ___________________________________________
Address: ____________________________________ City: _______________________ State: ___________ Zip Code: ________________________
1.
Owner hereby applies for a permit to install stub-ins at the locations listed below.
2.
At each location, Owner will install a tap, a valve at the property line, a meter pit and yoke, and a service line from the tap to 5 feet
past the meter pit.
3.
Use of water from a stub-in is prohibited. Any unauthorized use of water may result in cancellation of the stub-in permit. If the per-
mit is cancelled, Denver Water may in its discretion disconnect the stub-in at the main at Owner’s expense.
Stub In Location: County: _______________________ Subdivision Name & Filing #: ____________________________ Zip code: _________________
Address to be served
Block
Lot No.
Tap Size
Sq. Ft.
No. of
Tap Number
No.
(Lot Size)
Units
(Completed by
One address per line (not for fire lines)
(above 1
DW)
unit)
0.00
The following fees apply per connection: $ 280 for each 2” and smaller taps
No. __________ $__________
0.00
$100 for each 3” and larger taps
No. __________ $_________
0.00
Total ………………………………
$__________
(Payable to Denver Water)
1.
Owner agrees to pay an annual monitoring fee on the anniversary date of the issuance of the Stub-in Permit until the Permit is
converted to a Standard Water Supply License
2.
Owner bears sole responsibility for maintenance and repair of all stub-ins listed.
*FEES ARE SUBJECT TO CHANGE & PAYMENT IS REQUIRED WITH APPLICATION
Owner/Agent Signature: _____________________________________________________________Date: ______________________
Outside Denver locations: The stub-in locations listed here are hereby approved for connection to facilities within the
Distributor’s Contract Service Area.
Distributor Name: ____________________________________________________________________________________
Approved by: __________________________________Title: __________________________________Date: __________________
Denver Water office use only:
Tap numbers: __________________ - __________________
Plan ID #: ___________________ Participation #: _______________________ Completion date: ____________
4052 6/15
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