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CALHOUN COUNTY RURAL WATER DISTRICT
16712 ILLINOIS RIVER ROAD
HARDIN, IL 62047
PH. 618.576.2482
USER CONTRACT
_______________________I/We, hereby request permission to make an individual connection to the Calhoun County Rural Water District system. Our mailing address is/will be __________________________________________ Our phone number _____________ . The individual connection is to be at our business/home located at _______________________________________ . The licensed plumber who will make the connection to the District’s water main is
_________________________.
The individual connection tap-on fee is $1,800.00. For this fee the user is provided the privilege of connecting onto the system. Also, the District will provide the following material; water main saddle and corporation stop, service line and tracer wire from the main to the meter (up to 100 feet), meter yoke with regulating valve (if needed), 3/4” x 5/8” meter, meter tile, and meter lid.
The District will supply no labor, trenching, installation, or road boring. The plumber approved by CCRW shall supply all labor, trenching, installation, boring and any material not provided by the District. All workmanship and installation shall be in accordance with State, Local and District laws, rules and regulations and shall be observed by the District’s operator prior to covering up the work.
The meter shall be placed in a location determined by the District near the public road right-of-way. The District’s maintenance and ownership shall end at the meter. Water charges will begin the day of connection to the District’s main. Acceptance of this request by the District is subject to availability of sufficient pressure and current capacity.
If requested, I/We, hereby shall grant the District a perpetual easement in, over and upon, any land in which I/We have any ownership interest (this includes land I/We currently have or in the future obtain any ownership interest in) with the right to erect, maintain, replace/remove water pipelines and appurtenances. I further agree that any unpaid bills by either myself or any interested parties occupying said property shall constitute a lien against this real estate as described above.
______________________________________PROPERTY OWNER
______________________________ JOINT PROPERTY OWNER(S)
DATE: ____________________
PAYMENT RECEIVED AND CONNECTION APPROVED:_________________________
DISTRICT REPRESENTATIVE _________________________________
DATE: _________________
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FOR STATISTICAL PURPOSES ONLY: (Optional)
“The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race, ethnicity and sex of applicants on the basis of visual observation or surname.”
___ I do not wish to furnish this information
Ethnicity:
___ Hispanic or Latino
___ Not Hispanic or Latino
Race: (Mark all that apply)
___ White
___ Black or African American
___ American Indian or Alaska Native
___ Asian
___ Native Hawaiian or Other Pacific Islander
Sex:
___ Male
___ Female
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