NEW SERVICE INTAKE FORM
This form is only necessary if there is not an ongoing ABCWUA Work, Order, Availability Statement, or Connection Permit.

Contact:

Contact Name:

Phone Number:

Email address*

Alternate Phone Number:

Address of Property to be Served:

Address:

UPC Number (Parcel ID)

City:

State:

Zip Code:

Current Services Information: Indicate if and how the property may or not be receiving service:

Water:

None

Well

Existing ABCWUA Water Service

Account Number:

Other

Other Description:

Sanitary Sewer:

None

Septic

Existing ABCWUA Water Service

Account Number:

Other

Other Description:

Existing Conditions: Indicate if any of the following currently exist for the property:

Unused water meter box

Sanitary sewer stub

Requested Services Information: Indicate what additional services are desired for the property:

Water

Fire line of fire hydrant

Irrigation

Small meter service (up to and including a 2” meter size, typical service size for single family is ¾”)

Small Meter Size:

Large meter service (3" meter size or larger)

Large Meter Size:

Sewer

Sanitary Sewer

Development Information Provide a description of the development AND select the applicable development type below.

Description:

Existing Development

Single family resident lot

Commercial

Industrial

Institutional

Mulit-family

New Development

Single family resident lot

Residential subdivision

Commercial

Industrial

Institutional

Multi-family

Redevelopment

Single family residential lot

Commercial

Industrial

Institutional

Multi-family

Additional Information: Requestor Notes:

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