Tap Request Form 5/Part 5 - Form 1.1 Residentia… · This form may be returned to HNWS Customer...
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GUIDELINES, STANDARDS, AND SPECIFICATIONS FORMS FORM 1.1 RESIDENTIAL TAP REQUEST 8574 Turkey Bluff Road Navarre, Florida 32566 p: (850) 939-2427 Residential Tap Request Form REV. 1-7-2020 This form serves as a formal, written request by a customer of HNWS to initiate a tap for water or sewer services. Additional information regarding impact fees may be found in the Impact Fee Policy, which a copy of can be acquired upon request. No discounts of any kind are offered on impact fees and the impact fees are non-negotiable. A building plan of the house and any associated structures must be provided in order for HNWS to complete this form and initiate the Tap Request. Individual Tap Request Forms must be completed for each address requesting services. Tap Requests are subject to the HNWS Guidelines, Standards, and Specifications and do not represent an agreement of HNWS to install the tap. Please be aware that if the home address is not clearly visible from the road, it could result in a delay of services being established. Any connections that take place within FDOT ROW are the responsibility of the customer. Contact Name: LAST FIRST MIDDLE INITIAL Company Name: Billing/Mailing Address: PHYSICAL ADDR CITY, ST ZIP Business Tax ID #: REQUIRED FOR CONTRACTORS AND HOME BUILDERS Driver's License #: SSN: REQUIRED FOR HOME OWNER REQUIRED FOR HOME OWNER Phone: E-Mail Address: Information for Lot requesting services: Address: PHYSICAL ADDR CITY, ST ZIP Address Line 2: SUBDIVISION OR OTHER LOT/BLOCK PROPERTY APPRAISER ID Building Square Footage: Date of Tap Request: Please indicate below the date that the property was purchased (optional) and the date that the impact fee will actually be paid by (required). Prices and availability are only valid for 60 days and are subject to change. HNWS will require a new Tap Request Form for any fee payments that exceed 60 days from the Date of Tap Request on this form. Property Purchase Date: Expected Date of Tap Need: REQUIRED Services Requested: Water Sewer (X all that apply) SEWER TYPE - COMPLETED BY HNWS Fee Information (Completed by HNWS): Estimated Impact Fees: Water Sewer Deposits or Other: Water Sewer Other Total Fees Due: This form may be returned to HNWS Customer Service by any of the following methods: 1. E-Mail (preferred) to [email protected]. 2. Directly in person, which Customer Service may be reached at (850) 939-2427. 3. Fax, (850) 939-9541.
Transcript of Tap Request Form 5/Part 5 - Form 1.1 Residentia… · This form may be returned to HNWS Customer...
GUIDELINES, STANDARDS, AND SPECIFICATIONS FORMS
FORM 1.1 RESIDENTIAL TAP REQUEST
8574 Turkey Bluff Road Navarre, Florida 32566 p: (850) 939-2427
Residential Tap Request Form REV. 1-7-2020This form serves as a formal, written request by a customer of HNWS to initiate a tap for water or sewer services. Additional information regarding impact fees may be found in the Impact Fee Policy, which a copy of can be acquired upon request. No discounts of any kind are offered on impact fees and the impact fees are non-negotiable. A building plan of the house and any associated structures must be provided in order for HNWS to complete this form and initiate the Tap Request. Individual Tap Request Forms must be completed for each address requesting services. Tap Requests are subject to the HNWS Guidelines, Standards, and Specifications and do not represent an agreement of HNWS to install the tap. Please be aware that if the home address is not clearly visible from the road, it could result in a delay of services being established. Any connections that take place within FDOT ROW are the responsibility of the customer.
Contact Name: LAST FIRST MIDDLE INITIAL
Company Name:
Billing/Mailing Address: PHYSICAL ADDR CITY, ST ZIP
Business Tax ID #: REQUIRED FOR CONTRACTORS AND HOME BUILDERS
Driver's License #: SSN: REQUIRED FOR HOME OWNER REQUIRED FOR HOME OWNER
Phone: E-Mail Address:
Information for Lot requesting services:
Address: PHYSICAL ADDR CITY, ST ZIP
Address Line 2: SUBDIVISION OR OTHER LOT/BLOCK PROPERTY APPRAISER ID
Building Square Footage: Date of Tap Request:
Please indicate below the date that the property was purchased (optional) and the date that the impact fee will actually be paid by (required). Prices and availability are only valid for 60 days and are subject to change. HNWS will require a new Tap Request Form for any fee payments that exceed 60 days from the Date of Tap Request on this form.
Property Purchase Date: Expected Date of Tap Need: REQUIRED
Services Requested: Water Sewer (X all that apply) SEWER TYPE - COMPLETED BY HNWS
Fee Information (Completed by HNWS):
Estimated Impact Fees: Water Sewer
Deposits or Other: Water Sewer Other
Total Fees Due:
This form may be returned to HNWS Customer Service by any of the following methods: 1. E-Mail (preferred) to [email protected]. Directly in person, which Customer Service may be reached at (850) 939-2427.3. Fax, (850) 939-9541.
