Request Termination of Service

Start/Stop/Change Service

Request Termination of Service

Posted on July 30, 2019

by Lakeway Admin

Note: This form will only be processed if request is made by the current customer(s) at the service address.

If you prefer, you may instead print and mail or deliver this form. [ Printable Version ]
I am requesting service to be terminated at the following service address. I understand that I may request any date in the future to terminate service, but LMUD requires at least 24-business hours to complete the request. If I back-date this request, LMUD will correct the date to the earliest available date to disconnect service.
Name*
First Last
Service Address*
Street Address Address Line 2 City State Zip Code
Effective Date*
Date Format: MM slash DD slash YYYY

Selection date must be Monday thru Friday excluding Holidays and (1) business day prior to Today’s Date
Please send my final bill and/or refund to the following address:
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I am aware that my water, wastewater, and/or reuse service will be terminated at the above service address on the above date between 8:00am and 5:00pm. If I need to change the above date, I understand I am responsible for calling LMUD at 512-261-6222 at least one (1) business day prior to the requested termination date and will submit a new Request for Termination of Service form. I am aware that LMUD will charge a $50.00 service fee to reschedule to another date, reconnect service, or cancel the termination request if I do not notify LMUD at least one (1) business day prior to the requested termination date.
FOR AUTO-DRAFT CUSTOMERS ONLY
- I would like my final bill to be auto-drafted per my method on file as soon as my final bill is available.
If left un-checked we will email and/or mail your final bill as soon as it is available.
Signature
Date
Date Format: MM slash DD slash YYYY
Phone*
Email*
If you mail, email or fax this form, it is your responsibility to verify that we received it.

Completing this form does not automatically terminate recurring bank/credit card drafting. To terminate automatic drafting prior to your final bill being drafted, fill out the “Cancel Automatic Drafting” form or contact the District Office. Otherwise, we will remove your automatic drafting once your account has a zero balance.
Name
This field is for validation purposes and should be left unchanged.

Customers

Contract For Installation And Fee Schedule For Out Of District Wastewater Project (ODWW Project) For Lakeway Subdivision, Sections 1 – 17

Posted on October 3, 2019

by Lakeway Admin

Before filling out this form, please call Stephanie Threinen at our main office at (512) 261-6222 ext. 175 to confirm your location is eligible to complete this form at this time.

If you prefer, you may instead print and mail or deliver this form. [ Printable Version ].

Purpose and Use:
This form is required by submission from all current property owners (“Property Owner”) at Service Addresses in Lakeway Subdivision, Sections 1 - 17, City of Lakeway, Travis County in order to request or decline the installation of a grinder pump system at the Service Address in order to connect the Service Address to the public wastewater system being installed by LMUD as part of the ODWW Project
- within the boundaries of Phase 1 of the ODWW Project (“Phase 1”) or
- within boundaries of Phase 2 of the ODWW Project (“Phase 2”)
To determine whether your Service Address is in Phase 1 or Phase 2, view the map at www.lakewaymud.org/update/phase-1-and-phase-2-map-for-odww-project. If you are unsure, contact LMUD at (512) 261-6222 x110.
Property Owner Information:
Property Owner #1 Name
First Middle Last
Property Owner #2 Name
First Middle Last
Service Address
Street Address Address Line 2 City State Zip Code
Phone (main)
Phone (cell)
Email
Estimated Project Schedule:
- The first LMUD wastewater connections to the approximately 330 service addresses with the Phase 1 project area are anticipated to commence in March 2021 (the “Phase 1 Initial Connection Date”).
- The first LMUD wastewater connections to the approximately 900 service addresses within the Phase 2 project are anticipated to commence in January 2024. (the “Phase 2 Initial Connection Date”).
- DISCLAIMER: The project schedule, including Anticipated Connection Date, is subject to change without further notice to Property Owner. Please check LMUD’s website regularly for project updates at: www.lakewaymud.org/odww-project
Connection Options:
For Service Addresses within Phase 1 project area
- I request Early Connection (before the Phase 1 Initial Connection Date, subject to LMUD approval)*
- I request Regular Connection (on or after the Phase 1 Initial Connection Date)
- I request Late Connection (after Service Address has a recorded Decline Connection on file with LMUD)*
- I decline Connection (“Decline Connection”)
For Service Addresses within Phase 2 project area:
- I request Early Connection (before the Phase 2 Initial Connection Date, subject to LMUD approval)*
- I request Regular Connection (on or after the Phase 2 Initial Connection Date)
- I request Late Connection (after Service Address has a recorded Decline Connection on file with LMUD)*
- I decline Connection (“Decline Connection”)
For all connection requests, please select one:
- Emergency Connection
- New Construction
- Remodel
- Other
Other
Anticipated Connection Date:
Date Format: MM slash DD slash YYYY
Fees:

IMPORTANT INFORMATION REGARDING REQUESTS FOR EARLY AND LATE CONNECTIONS*
1. The following non-refundable One-Time Charges must be paid with this Application:
Application Fee	$100
Capacity Reservation Charge	$3,675*
Plumbing Inspection Charge	$225
TOTAL NON-REFUNDABLE ONE-TIME CHARGES FOR EARLY OR LATE CONNECTION REQUESTS	$4,000
*Increased to $3,675 on Jan 1, 2020 and then an additional $125 each year thereafter.
2. 220 volt electricity to support an electrical panel to the grinder pump must be supplied by Property Owner at Property Owner’s sole cost and expense by a licensed professional electrician registered to do business in Texas prior to and as a condition of initiating wastewater service from LMUD through the ODWW Project.

Additional Terms and Conditions:
The following additional terms and conditions apply to all connection requests as part of the ODWW Project. Please review this information carefully:
- Property Owner Declining Connection: Property Owners who selected “I decline Connection”:
- Property Owner Requesting Early Connection: Property Owners who selected “I request Early Connection”:
- Property Owner selecting Regular Connection:
- Notice regarding Grinder Pump Systems:
- Customers with Existing Septic Tanks:
- Notice of Additional Required Documents and Fees:
Property Owner Certification And Signatures:
By my/our signature(s) below, I/we hereby certify the information provided herein and following statements are true and correct:

I/we am/are the current owner(s) of the property located at the Service Address listed above [referred to as the "Property Owner" herein].

Property Owner has provided their option to request or decline the installation of a grinder pump system at the Service Address listed above in order to connect the Service Address to the public wastewater system being installed by LMUD as part of the ODWW Project.

Property Owner has read and understands the information provided herein, including the Estimated Project Schedule, Connection Options, Fees, and Additional Terms and Conditions.

Property Owner hereby agrees to pay all rates, fees, and charges referred to herein and to comply with all Rate Orders, other orders, rules, regulations, codes, and guidelines of LMUD now existing or as may be revised by LMUD in the future in LMUD’s sole discretion. Property Owner further agrees to comply with and be bound by LMUD’s Rate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion, and agrees to the imposition and payment of fines and penalties for noncompliance.

This Agreement shall become effective when signed by a duly authorized representative of LMUD.
Property Owner #1
Name
First Last
Signature
Initials
Date
Date Format: MM slash DD slash YYYY
Property Owner #2
Name
First Last
Signature
Initials
Date
Date Format: MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

Customers

Application and Service Contract for Water and/or Wastewater Services

Posted on July 2, 2019

by Lakeway Admin

STOP! Before filling out this form, please call our main office at (512) 261-6222 ext. 110 to confirm your location is serviced by Lakeway MUD.

If you prefer, you may instead print and mail or deliver this form. [ Printable Version ]
Date Service is Requested to Begin
Date Service to Begin*
Please schedule service start date Mon. – Fri. only, excluding holidays. Allow at least 1 (one) business day lead time.
(If you are part of the ODWW Project, please enter 9/9/9999)
Date Format: MM slash DD slash YYYY
Customer Information
Customer #1 Name*
First Middle Initial Last
Identification
- Social Security #
- Driver's License #
- Other Government Issued ID # and Description
Social Security #
Driver's License #
State of Issuance
Other Government Issued ID # and Description
Do you have a Co-Applicant?
- Yes
- No
Customer #2 Information
Customer #2 Name*
First Middle Last
Identification
- Social Security #
- Driver's License #
- Other Government Issued ID # and Description
Social Security #
Driver's License #
State of Issuance
Other Government Issued ID # and Description
Service Address
Service Address*
Street Address Address Line 2 City State Zip Code
Telephone (Main)*
Telephone (Alternate)
Email*
Billing Address
Billing Address
Same as Service Address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Payment
LMUD accepts payments made by credit card or debit card (one-time or automatically recurring), personal check, cashier’s check, money order, bank draft (one-time or automatically recurring), or on-line. A return item feewill be assessed if payment is rejected. A late fee may also be assessed.
Paperless (Emailed) Billing Requested
If yes, provide a valid email address under the Customer Information section, above
- Yes
- No
Automatically Recurring Payment Requested
- Yes
- No
Complete the Authorization for Automatic Payments form and return it to LMUD.
Lakeway Municipal Utility District
Administrative Office
1097 Lohmans Crossing
Lakeway TX 78734-445
Fax: (512) 261-6681

Please do not submit this form via email.
Customer Obligations
All Customers:
Customer must pay a nonrefundable Service Fee, which is due at the time of submittal of an Application and Service Contract. In addition, once service commences, Customer must pay all rates, fees, and charges and comply with all rules and regulations of LMUD now existing or as may be revised in the future.
Water Customers:
Customer shall install, at Customer’s own expense, a tap (if no tap is preexisting), a water service line commencing at LMUD’s water meter and connecting to the Customer’s home or place of use, and a cut-off valve. Customer shall be fully responsible for the service line from the water meter to Customer’s home or place of use, including the installation of an approved back-flow device if required. Tampering with LMUD’s water meter or using LMUD’s water cutoff valve is prohibited.
Wastewater Customers:
Customer shall install, at Customer’s expense, a tap (if no tap is preexisting) and aback-up relief valve, and must request inspection of same by LMUD after installation. More information is available on LMUD’s website at: https://www.lakewaymud.org/service-providers/guideline-requirement-documentation/wastewater-back-up-relief-valve-installation-guide.
Is there a grinder pump at the Service Address?
- Yes
- No
- Unsure
Important Note: If a grinder pump is present or required, LMUD will provide maintenance per the FY 2019/2020 Rate Order update.

For LMUD-installed grinder pumps, additional installation fees may apply.

For customer-installed grinder pumps, some repairs may require additional fees.

For all customers with a grinder pump, please call us to request a work order for maintenance to be performed
General Terms of Service
After approval of this Service Contract by LMUD, LMUD will sell and deliver water and/or wastewater to the Customer, and the Customer shall receive and pay for such service(s) in accordance with LMUD’s most current Rate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion. As evidenced by its signature below, Customer expressly agrees to comply with and be bound by Lustrate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion, and agrees to the imposition and payment of fines and penalties for noncompliance.

LMUD has the authority to discontinue service to any Customer not complying with Lustrate Order, policies, rules, or regulations, or for non-payment of utility fees and other Mischarges. If service is discontinued, service will not be re-established until Customer has corrected all conditions that caused the termination. In some cases, a new Application for Service and Contract for Service must be submitted.
Rates, Fees, and Charges
LMUD’s rates, fees and charges shall be those adopted by the LMUD Board of Directors in its Rate Order, which may be revised from time to time by LMUD’s Board of Directors in its sole discretion. A brief summary LMUD’s current rates, fees and charges fees are available at LMUD’s Administrative Offices and on-line.
Easement
By the signature(s) below, the Customer(s) hereby grant(s)to LMUD any easements or rights-of-way required for the purpose of installing, inspecting, maintaining, and operating pipelines, meters, valves and any other equipment that may be required to extend or improve service by LMUD to Customer.
Notice of Right of Confidentiality
Section 182.052 of the Texas Utilities Code requires LMUD to notify customers of their right to confidentiality. You are hereby informed that you have the right to request confidentiality of your address, telephone number, social security number and any information relating to the volume or units of utility usage and the amounts billed to or collected from you for utility usage, as contained in LMUD’s records. To exercise your rights, please complete the Notification of Right of Confidentiality of Customer Information and return it to LMUD.
Customer Certification and Signatures
By my/our signature(s) below, I/we hereby certify the information provided herein and following statements are true and correct:
I/we am/are the*
- Owner
- Lessee
of the property located at the Service Address listed above [referred to as the "Customer" herein]. Customer desires to contract with Lakeway Municipal Utility District (LMUD) to receive water and/or wastewater service from LMUD to the property located at the Service Address listed above.
Customer hereby agrees to pay all rates, fees, and charges and to comply with all Rate Orders, other orders, rules, regulations, codes, and guidelines of LMUD now existing or as may be revised by LMUD in the future in LMUD’s sole discretion. Customer further agrees to comply with and be bound by LMUD’s Rate Order, other orders, rules and regulations, policies, guidelines, Water Conservation Plan, and Drought Contingency Plan, as the same may be amended from time to time by LMUD in its sole discretion, and agrees to the imposition and payment of fines and penalties for noncompliance

CUSTOMER AGREES TO WAIVE, RELEASE, AND HOLD LMUD HARMLESS FROM ANY CLAIMS AND DAMAGES RESULTING FROM MALFUNCTION, FAILURE, OR ABSENCE OF CHECK VALVES, BACKFLOW PREVENTION DEVICES, AND PRESSURE RELIEF VALVES, INCLUDING WITHOUT LIMITATION, DAMAGES TO PERSONSOR PROPERTY, DIRECT DAMAGES, SPECIAL DAMAGES, INCIDENTAL DAMAGES, CONSEQUENTIAL DAMAGES, OR LOSS OF PROFIT OR REVENUE.

This Agreement shall become effective when signed by a duly authorized representative of LMUD
Customer Signature*
Name*
First Last
Customer Initials
Date*
Date Format: MM slash DD slash YYYY
Customer #2 Signature
Customer #2 Name
First Last
Customer #2 Signature Date
Date Format: MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.