Water Service Connection Application

HARWICH WATER DEPARTMENT
TOWN OF HARWICH
196 CHATHAM ROAD
HARWICH, MASSACHUSETTS 02645
TELEPHONE: (508) 432-0304
FAX: (508) 430-7520

BOARD OF WATER COMMISSIONERS

______________________________

DATE:________________

SERVICE #:___________

I hereby apply for water service connection at:

House # __________ Street ________________________________________________

Lot # __________ Village: __________________________________________________

Assessor's Map: ___________________ Parcel: _______________

Owner of Property: ______________________________________________________________

Billing Address: _________________________________________________________________

City/Town: ______________________________ State: __________ Zip Code: ____________

Telephone No: _________________________

I agree that as soon as I connect to the water system and become a take, I will pay for same and abide by all the rules and regulations now in force or to be established by the Board of Water Commissioners.

Signature of Owner: ________________________________________________________________

Name of Builder: __________________________________________________________________

Telephone No: _________________________

Name of Water Installer: ____________________________________________________________

APPLICATIONS MUST BE COMPLETED IN FULL PRIOR TO APPROVAL.
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For Office Use Only:
Reading Book # _________ Page #_________