Liberty County UtilitiesService Agreement Name of Applicant(Required) First Last Service Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Billing Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell Phone(Required)Email(Required) Section Block Lot Number WATER REGULATIONSPURPOSE: THE UTILITY IS RESPONSIBLE FOR PROTECTING THE DRINKING WATER SUPPLY FROM CONTAMINATION OR POLLUTION, WHICH COULD RESULT FROM IMPROPER PLUMBING PRACTICES. THE PURPOSE OF THIS SERVICE AGREEMENT IS TO NOTIFY CUSTOMER OF THE PLUMBING RESTRICTIONS, WHICH ARE IN PLACE TO PROVIDE THIS PROTECTION. THE UTILITY ENFORCES THESE RESTRICTIONS TO ENSURE THE PUBLIC HEALTH AND WELFARE. EACH CUSTOMER MUST SIGN THIS AGREEMENT BEFORE THE UTILITY WILL BEGIN SERVICE. IN ADDITION, WHEN SERVICE TO AN EXISTING CONNECTION HAS BEEN SUSPENDED OR TERMINATED, THE UTILITY WILL NOT RE-ESTABLISH SERVICE UNLESS IT HAS A SIGNED COPY OF THE AGREEMENT. THE UTILITY AGREES TO SELL AND DELIVER WATER TO THE CUSTOMER AND THE CUSTOMER AGREES TO PURCHASE AND RECEIVE WATER FROM THE UTILITY IN ACCORDANCE WITH THE RULES AND REGULATIONS OF THE UTILITY AS INCLUDED IN ITS APPROVED TARIFF ON FILE WITH THE UTILITY AND THE TEXAS NATURAL RESOURCE CONSERVATION COMMISSION. ALL WATER WILL BE MEASURED BY METERS THAT ARE FURNISHED, INSTALLED, OWNED AND MAINTAINED BY THE UTILITY. THE METER AND OR CONNECTION IS FOR THE SOLE USE OF THE CUSTOMER TO SERVE WATER TO ONE DWELLING, BUSINESS OR PROPERTY. THE CUSTOMER SHALL NOT SHARE, RESALE, OR SUBMETER WATER TO ANY OTHER DWELLING, BUSINESS, PROPERTY, ETC. WITHOUT THE SPECIFIC WRITTEN AUTHORIZATION OF THE UTILITY AND IN COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS. THE UTILITY HAS THE RIGHT TO LOCATE A WATER SERVICE METER AND PIPE NECESSARY TO CONNECT THE METER ON THE PROPERTY OF THE CUSTOMER. THE CUSTOMER WILL ALLOW THE UTILITY ACCESS AT ALL REASONABLE TIMES TO ITS PROPERTY AND EQUIPMENT LOCATED UPON CUSTOMERS PREMISES FOR THE LIMITED PURPOSE OF READING THE WATER METER, REPAIRING OR REPLACING EXISTING FACILITIES AND THE INSPECTION OF CUSTOMERS FACILITIES TO CHECK FOR ILLEGAL CONNECTION OR UNSAFE PLUMBING PRACTICES OR CROSS CONNECTIONS, IN COMPLIANCE WITH THE REQUIREMENT OF THE TEXAS NATURAL RESOURCE CONSERVATION COMMISSION “RULES AND REGULATIONS FOR PUBLIC WATER SYSTEMS.” THE CUSTOMER WILL INSTALL, AT THEIR OWN EXPENSE, A SERVICE LINE FROM THE WATER METER TO THE POINT OF USE WHICH INCLUDES A CUTOFF VALVE ON THE CUSTOMER SIDE OF THE WATER METER. THE CUSTOMER WILL BE RESPONSIBLE FOR THE MAINTENANCE AND REPAIR OF THE SERVICE LINE. THE CUSTOMER SHALL HOLD THE UTILITY HARMLESS FROM ANY AND ALL CLAIMS OR DEMANDS FOR DAMAGE TO REAL OR PERSONAL PROPERTY OCCURRING FROM THE POINT THE CUSTOMER TIES ON TO THE WATER METER TO THE FINAL DESTINATION OF THE LINE INSTALLED BY THE CUSTOMER. THE CUSTOMER AGREES TO GRANT TO THE UTILITY EASEMENT/RIGHT-OF-WAY FOR THE PURPOSE OF INSTALLING, MAINTAINING AND OPERATING SUCH PIPE LINES, METERS, VALVES AND ANY OTHER EQUIPMENT WHICH MAY BE DEEMED NECESSARY FOR THE PROVISION OF THE UTILITY SERVICE TO THAT CUSTOMER. THE UTILITY WILL ATTEMPT TO RESTORE THE CUSTOMER’S PROPERTY TO ITS ORIGINAL CONDITION AFTER INSTALLATION OR REPAIRS. THIS EASEMENT MAY BE IN SUCH FORM AS IS REQUIRED BY THE UTILITY. THE CUSTOMER AGREES NOT TO INTERFERE WITH THE UTILITY’S EMPLOYEES IN THE DISCHARGE OF THEIR DUTIES. THE CUSTOMER WILL NOT PERMIT ANYONE EXCEPT THE UTILITY’S EMPLOYEES TO TAMPER WITH OR INTERFERE WITH ANY EQUIPMENT INSTALLED ON THE CUSTOMERS PREMISES.SEWER REGULATIONSTHE UTILITY ONLY PROVIDES “SEWAGE” COLLECTION AND DISPOSAL SERVICE TO THE PUBLIC. THIS SERVICE IS LIMITED TO THE COLLECTION, TREATMENT AND DISPOSAL OF WATERBORNE HUMAN WASTE AND WASTE FROM DOMESTIC ACTIVITIES SUCH AS WASHING, BATHING, AND FOOD PREPARATION. THIS SERVICE DOES NOT INCLUDE THE COLLECTION, TREATMENT OR DISPOSAL OF WASTE OF SUCH HIGH CONCENTRATION CHARACTERISTICS THAT IT CANNOT BE PROCESSED BY THE UTILITY’S STATE APPROVED WASTEWATER TREATMENT PLANT WITHIN THE PARAMETERS OF THE UTILITY’S STATE AND FEDERAL WASTE WATER DISCHARGE PERMITS. THIS SERVICE DOES NOT INCLUDE THE COLLECTION AND DISPOSAL OF STORM WATERS OR RUN OFF WATERS, WHICH MAY NOT BE DIVERTED INTO OR DRAINED INTO THE UTILITY’S COLLECTION SYSTEM. THE CUSTOMER WILL INSTALL, AT THEIR OWN EXPENSE, A SERVICE LINE FROM THEIR DWELLING TO THE UTILITY’S CONNECTION, WHICH INCLUDES A CLEAN-OUT. THE CUSTOMER WILL BE RESPONSIBLE FOR THE MAINTENANCE AND REPAIR OF THE SERVICE LINE.PLUMBING REGULATIONSTHE FOLLOWING UNDESIRABLE PLUMBING PRACTICES ARE PROHIBITED BY STATE REGULATION. 1. NO DIRECT CONNECTION BETWEEN THE PUBLIC DRINKING WATER SUPPLY AND A POTENTIAL SOURCE OF CONTAMINATION IS PERMITTED. POTENTIAL SOURCE OF CONTAMINATION SHALL BE ISOLATED FROM THE PUBLIC WATER SYSTEM BY AN AIR-GAP OR AN APPROPRIATE BACKFLOW PREVENTION DEVICE. 2. NO CROSS-CONNECTION BETWEEN THE PUBLIC DRINKING WATER SUPPLY AND A PRIVATE WATER SYSTEM IS PERMITTED. 3. NO CONNECTION WHICH ALLOWS WATER TO BE RETURNED TO THE PUBLIC DRINKING WATER SUPPLY IS PERMITTED. 4. NO PIPE OR PIPE FITTING WHICH CONTAINS MORE THAN 0.25% LEAD MAY BE USED FOR THE INSTALLATION OR REPAIR OF PLUMBING AT ANY CONNECTION. 5. NO SOLDER OR FLUX WHICH CONTAINS MORE THAN 0.2% LEAD CAN BE USED FOR THE INSTALLATION OR REPAIR OF PLUMBING AT ANY CONNECTION WHICH PROVIDES WATER FOR HUMAN USE. 6. NO PLUMBING FIXTURE SHALL BE INSTALLED WHICH IS NOT IN COMPLIANCE WITH A STATE APPROVED PLUMBING CODE.Date Service to Start(Required) Check Applicable Items - Type of Service: Water Sewer I have read and understand the Water/Sewer/Plumbing Regulations listed above.(Required) Yes, I have read and understand the Regulations that apply to my requested Service type. Must Select One of The Options Below:(Required) Owner Renter Commercial Water Meter Size: Standard Other If Other State Size: Service AgreementTHE FOLLOWING ARE THE TERMS OF THE SERVICE AGREEMENT BETWEEN THE UTILITY AND THE CUSTOMER. 1. THE WATER SYSTEM WILL MAINTAIN A COPY OF THIS AGREEMENT AS LONG AS THE CUSTOMER AND/OR THE PREMISES IS CONNECTED TO THE WATER SYSTEM. 2. THE CUSTOMER SHALL ALLOW HIS PROPERTY TO BE INSPECTED FOR POSSIBLE CROSS-CONNECTIONS AND OTHER UNDESIRABLE PLUMBING PRACTICES. THESE INSPECTIONS SHALL BE CONDUCTED BY THE WATER SYSTEM OR ITS DESIGNATED AGENT PRIOR TO INITIATING SERVICE AND PERIODICALLY THEREAFTER. THE INSPECTION SHALL BE CONDUCTED DURING THE WATER SYSTEMS NORMAL BUSINESS HOURS. 3. THE WATER SYSTEMS SHALL NOTIFY THE CUSTOMER IN WRITING OF ANY CROSS-CONNECTIONS OR OTHER UNDESIRABLE PLUMBING PRACTICE WHICH HAS BEEN IDENTIFIED DURING THE INITIAL INSPECTION OR THE PERIODIC RE-INSPECTION. 4. THE CUSTOMER SHALL IMMEDIATELY CORRECT ANY UNDESIRABLE PLUMBING PRACTICES ON HIS PREMISES. 5. THE CUSTOMER SHALL, AT HIS EXPENSE, PROPERLY INSTALL, TEST AND MAIN-TAIN ANY BACKFLOW PREVENTION DEVICE REQUIRED BY THE WATER SYSTEM. COPIES OF ALL TESTING AND MAINTENANCE RECORDS SHALL BE PROVIDED TO THE WATER SYSTEM. CUSTOMER AGREEMENT: BY SIGNING THIS APPLICATION FOR PUBLIC UTILITY SERVICE, I AGREE TO COMPLY WITH THE UTILITY’S TARIFF AND ALL RULES AND REGULATIONS OF THE TCEQ AND OTHER APPLICABLE REGULATORY AGENCIES. I GUARANTEE PROMPT PAYMENT OF ALL UTILITY BILLS FOR THE SERVICE ADDRESS PRINTED ABOVE. I AGREE TO REMAIN RESPONSIBLE FOR UTILITY BILLS FOR THIS SERVICE ADDRESS FROM THE DATE SERVICE IS STARTED UNTIL THE DATE SERVICE IS TERMINATED. I UNDERSTAND THAT SERVICE WILL NOT BE TEMINATED VOLUNTARILY UNTIL I REQUEST IT IN WRITING. ENFORCEMENT: IF THE CUSTOMER FAILS TO COMPLY WITH THE TERMS OF THE SERVICE AGREEMENT, THE WATER SYSTEM SHALL, AT ITS OPTION, EITHER TERMINATE SERVICE OR PROPERLY INSTALL, TEST, AND MAINTAIN AN APPROPRIATE BACKFLOW PREVENTION DEVICE AT THE SERVICE CONNECTION. ANY EXPENSES ASSOCIATED WITH THE ENFORCMENT OF THIS AGREEMENT SHALL BE BILLED TO THE CUSTOMER.I have read and understand the Service Agreement listed above.(Required) Yes, I have read and understand the Service Agreement Date(Required) MM slash DD slash YYYY SignatureCAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Contact UsMailing Address:P.O BOX 70 • New Waverly, TX 77358Phone:832-941-1694Emailcustomerservice@libertycountyutilitiestx.com HomeInformationNew CustomersPay My Bill
