HANDY SANITARY DISTRICT	WATER& WASTEWATER
________________________________________________________________________________
Tap Application Form Fees for new taps are as follows: $900.00 tap fee, $100.00 meter deposit, and $25.00 membership fee. Handy Sanitary District (HSD) bills once a month. Water meters are read at the middle of the month, with bills being mailed out at the end of the month or the first of the next month. If you get 30 days behind in your payments, and do not pay the previous month's bill by the due date of the current bill, you will be placed on the cut-off list. If we cut your water off and lock your meter, it will cost $50.00 to reconnect during regular hours. However, before your water is turned back on, the total amount due must be paid in addition to the reconnect fee. When HSD employees install your meter, if you are unable to be present, you have two options. The first option is that HSD will turn your water on without you being present. However, if there is a leak, you will be required to pay for any water used. The second option is that HSD will not turn your water on when we install the meter, but you will need to contact HSD between the hours of 8 a.m. and 3 p.m., Monday through Friday, when you are ready to have your water service activated. By signing below, you waive any claims for damages that you may have against Handy Sanitary District. This is an Equal Opportunity facility. Federal law prohibits discrimination. To file a complaint of discrimination, write: USDA Director of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, D.C. 20250-9410. I have read this statement and agree with everything contained herein: DATE: ____________________________
NAME(S) FOR ACCOUNT:	_______________________________________________________
BILLING ADDRESS:	_______________________________________________________
	_______________________________________________________
PHYSICAL ADDRESS:	_______________________________________________________
(IF DIFFERENT)	_______________________________________________________
PHONE NUMBER(S):	_______________________________________________________
	_______________________________________________________
DRIVER LICENSE # (S):	_______________________________________________________
	_______________________________________________________
SIGNATURE(S):	_______________________________________________________
	_______________________________________________________
________________________________________________________________________________ P.O. Box 987, Denton, NC 27239 Phone (336) *59-2553     Fax (336) 859-3504