Rural Potable Water Servicing Agreement

Rural Potable Water Servicing Application

Rural Potable Water Servicing Policy #UT01

Water and Wastewater Systems Bylaw #403-2022

Please fill in your contact information as completely and accurately as possible.

Name

Mailing Address

Email

Phone Number

Legal Land Description

Rural Address

Is this location a permanent residence, with services?

Yes

No

Other

Is this a full time commercial business site?

Yes

No

Click on the highlighted link to read Rural Potable Water Servicing Policy#UT01 before proceeding.

I acknowledge I have read Policy #UT01

I understand that by checking this box I am stating that I have read Policy#UT01

Click on the highlighted link to read the Water and Wastewater Systems Bylaw #403-2022

I acknowledge I have read Bylaw #403-2022

I understand that by checking this box I am stating that I have read Bylaw #403-2022

By checking this box, which functions as your legal signature, you confirm that the information provided is as complete and accurate as possible, and that you agree to the terms and conditions of this form

I understand that checking this box constitutes a legal signature

Notice of Collection

Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of ensuring eligibility for water service connection, and facilitating the connection of rural water services. Upon appointment, your identifying information may be released to the general public. Direct any questions about this collection to: FOIP Coordinator, Saddle Hills County, RR 1, Spirit River, Alberta, Canada, T0H 3G0, 1-888-864-3760.

Please send me a pdf copy of this form

Yes

No

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Rural Potable Water Servicing Application

Rural Potable Water Servicing Policy #UT01