1. Applicant Information:

Name:*

Mailing Address:*

Mailing City:*

Mailing State:*

Mailing Zip Code:*

Phone Number:*

Email:*

2. Service Location:

Type of Property:* ResidentialCommercialIndustrial
Service Address:*

Parcel Number (if known):

Property Owner (if different):

Number of Units:

3. Type of Service Requested:

New Water Service:* YesNo
New Sewer Service:* YesNo
Water & Sewer Connection:* YesNo
Service Transfer:* YesNo
Temporary Service:* YesNo
Meter Size Requested (inches): 5/83/41Other
If you chose “Other” above, provide a specific size:

4. Contractor Information (if applicable):

Contractor Name:

Company Name:

Contractor Phone Number:

Contractor License Number:

5. Connection Information:

Date Service Requested:*

Water Tap Required:* YesNo
Sewer Tap Required:* YesNo
Comments / Special Instructions:*

Applicant Agreement:*

By submitting this form, I understand that all water and sewer connections must comply with City of Weippe ordinances, plumbing codes, and inspection requirements. I agree to pay all applicable connection fees, deposits, and monthly utility charges. I certify that the information provided in this application is true and correct. Furthermore, I agree with City of Weippe’s privacy policy statement, which can be found in the footer of this page.

I consent to having the City of Weippe collect my name and email to receive occasional announcements and newsletters. The City of Weippe will never sell your information, and you are welcome to opt-out of our mailing list at any time.
YesNo