LAKEWAY
MUNICIPAL UTILITY DISTRICT
APPLICATION
FOR SERVICE
date _______________
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Owners Name: |
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TELe
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Service Address: |
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LAKEWAY, TX |
787 |
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BILL TO: |
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SS# |
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ADDRESS: |
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Street
Address or P.O. Box # |
CITY/STATE/ZIP |
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TELE
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GRINDER
PUMP SYSTEM: |
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YES |
________
NO |
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The undersigned certifies that as Owner,
Builder, or Agent of Owner of Section _______________, Lot _______________,
____________________ Subdivision, for the granting of water and/or wastewater
service, to abide by, and pay and conform to all Rules, Regulations, Plumbing
Code Requirements, Charges and Fees of the Lakeway Municipal Utility District
and that the above information is true and correct to the best of my knowledge.
I hereby agree to locate and expose the appropriate wastewater tap
location (if applicable) prior to installation of the water meter or initiation
of any new construction of any kind. I
understand that the water meter will not be installed until the wastewater tap
location (if applicable) has been approved by the District for location and
flow.
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Name: |
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signature: |
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Please
Print |
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Owner / Builder / Other |
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DATE PAID: |
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RECEIVED BY: |
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New |
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Remodel |
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S/P |
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S/S |
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Other |
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*******************************************
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WATER
SERVICE |
WASTEWATER
SERVICE |
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4140- WT |
Meter Size |
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$ |
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4240- ST |
Tap Size |
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$ |
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4160- WI |
Plumbing Insp. Fees |
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4260- SI |
Plumbing Insp. Fees |
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4285- WA |
OD Application Fee |
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Approved/Denied * |
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4285- WA |
Capacity Reserve Fee |
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2140- SD |
S/D Receipt # |
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Other |
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1340- 31 |
Standby A/R |
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TOTAL FEES |
$ |
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*****************************************
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WORK
ORDER # |
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PLMB
CARD |
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PLMB
PERMIT |
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AVR |
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DATE
INSTALLED |
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METER # |
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BEGINNING
READ |
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PRESSURE PLANE |
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METER COUNT |
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MAP |
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S/B FINALED |
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NEW ACCT# |
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SEQ. # |
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* cc to RE