THE TORRINGTON WATER COMPANY

WATER SERVICE AVAILABILITY INQUIRY

AND APPLICATION FOR WATER SERVICE

Date: _______________

Address of Property:_________________________________________

If for one single family house describe location – on _________ side of

_____________ street between existing houses # ____ and #_______.

If for anything other than one single family house provide copy of Assessors map

or preliminary site plan.

Property Owner’s Name:

Mailing Address:

Telephone Number:

Service to be provided for:

______One single family home ______One duplex house

______Condominiums ______Commercial building

______Industrial building ______Private Fire Service

Signature of owner: ____________________________________

Printed Name: ____________________________________

Date:______________________

FOR OFFICE USE ONLY

Does Main Exist at location _______yes size of main ________

_______no – extension required

Static Pressure at site: ________

Account Number:_________________ Private Fire Acct Number:_____________

Meter Size: _________________ Backflow Acct Number: _____________

Service Size: _________________

Application Approved by: _____________________ Date: _______________

Company reply of availability or approval of service _________________

Comments: