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Hamlet Water/Sewer Application

Dwelling Type

Single Dwelling Unit

Multiple Dwelling Unit

Number of Users

Start Date

Legal Land Description

Tax Roll Number

Property Address

Address

Hamlet

Province

Postal Code

Mailing Address

Address

Town/Hamlet/Subdivision

Province

Postal Code

Applicant(s)

First Name

Last Name

Co-applicant First Name

Co-applicant Last Name

Phone: Residence

Phone: Business

E-mail

The appliant(s) must be the owner of the above residence to apply for utility services.

Previous Owner First Name

Previous Owner Last Name

THIS CONTRACT IS NOT TRANSFERABLE. THE UNDERSIGNED AGREES TO GIVE WRITTEN NOTICE BEFORE VACATING THE SAID PREMISES, AND TO BE LIABLE FOR ALL WATER AND SEWER CHARGES UNTIL SUCH WRITTEN NOTICE IS GIVEN.

OWNER ACCOUNTS IN ARREARS 90 DAYS FROM BILLING DATE WILL HAVE BALANCE DUE TRANSFERRED TO THE PROPERTY TAX ACCOUNT.

I declare the above statements are true to the best of my knowledge, information, and belief.

Applicant Signature

Clear

Co-applicant Signature

Clear

Protection of Privacy - Personal information is collected in accordance with Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act (the FOIP Act) and will be protected under Part 2 of that Act. It will be used for the purposes of administering the program or service for which the information is collected. Should you require further information about collection, use and disclosure of personal information, please contact the FOIP Coordinator at foip@countygp.ab.ca or call 780-532-9722.