P.O.BOX 595
ALPINE, ARIZONA 85920
928-339-4302
APPLICATION FOR SERVICE
NAME:________________________________________________________
MAILING ADDRESS:_____________________________________________________
_______________________________________________________________
TELEPHONE:___________________________________________________
SERVICE ADDRESS:____________________________________________
PARCEL#101-___________________________________________________
CONNECTION FEE IS $2,500.00 ( TWO THOUSAND FIVE HUNDERED DOLLARS)
MONTHLY SERVICE FEE:_______________________________________
TYPE OF SERVICE:______________________________________________________
Monthly service fee will commence 30 days after inspection.
The monthly service fee is due and payable upon receipt. If the service fee remains upaid for a period of 60 days the District may pursue legal resources to collect unpaid balances.
CUSTOMER SIGNATURE:_______________________________________
DATE:_________________________________________________________
For inspection call:Gavin Lamont at 521-3233 or the Alpine Sanitary District at 339-4302.
Call 24 hours prior to inspection time to schedule inspection.
Inspection Date:__________________Time:__________________________
Inspected by: ___________________________________________________
Remarks:________________________________________________________________________________
________________________________________________________________________________________
The sewer line and tap will be inspected and should not be covered until inspection is complete. Failure to comply will result in lines having to be exposed for inspection, cost of which will be responsibility of the property owner.
Revised: 1-03-03
Revised: 7-01-03
Alpine Sanitary District Rates and Fees Schedule
Alpine Sanitary District Request for Change in Billing Information
Alpine Sanitary District Application for Service
Alpine Sanitary District Building Sewer Specifications for Applicant Responsibility