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Email:

Subdivision:

Lot No or PIN:

Please indicate, if the service you are applying for is in one of the following areas - Candlewick Lakes, Hawthorn Woods, Manteno, or Peotone

II) CUSTOMER / BILLING INFORMATION :

Check here, if Customer / Billing Address is the same as Service Address Customer Name:

Billing Address:

City: State: ZIP:

Phone: Cell:

Email:

Is the property:

III) OWNER (If Property is rented):

Owner's Name:

Owner's Address:

City: State: ZIP:

Owner's Phone: Owner's Email:

IV) SERVICE INFORMATION:

Please check all that apply

New Construction The water plant fund - or tap-on

New Service fee is:

Additional Service

Change Service Size

Other The wastewater plant fund - or

Meter Only tap-on fee is:

Account Number:

OR if you have an existing service at this address FEES TOTAL: TBD Customer Number:

if you are an existing AQUA customer

V) WATER SERVICE INFORMATION:

Please check all that apply. Please note Fire and Irrigation usage on the Water Supply Fixture Unit Calculation sheet. Domestic Water Service "Service Line Sizing Worksheet" completed and signed Fire Sprinkler Service Anticipated Size of Service Line from Structure Irrigation Service to Property Line

Size of Meter Requested

Size of Service from Structure to Curb Box

Size of Existing Service (if applicable)

VI) METER LOCATION:

Unless special conditions warrant otherwise the Meter will be installed in a Meter Pit at the Property Line. If a meter pit cannot be installed, please provide justification. VII) COMMENTS:

Please enter ANY information you want to communicate to Aqua, i.e. larger service, and / or meter size than determined by calculator, any issues with the form etc. Single Family or 3 BR Apartment

2 BR Apartment

1 BR Apartment

Efficiency Apartment or Studio

Mobile Home

Please select one

OWNED or RENTED

Rev: Mar-2019 Application for Service Page 1 of 3

VIII) INSTRUCTIONS AND CONDITIONS FOR WATER SERVICE INSTALLATION: 1.) The applicant shall bear the entire cost of the service connection from structure to the meter pit up to the meter setting. 2.) All work shall be performed in accordance with Aqua Illinois, Inc.'s (Aqua) pre-approved written requirements for that service, and meet all state and local codes.

3.) All restorations needed, due to service tap, are the applicant's responsibility. 4.) No meter pits shall be installed in the sidewalk or driveway. 5.) Proposed location of meter pit requires Aqua's prior written approval. 6.) Non-Fire Service Line - Aqua or Aqua's representative shall make the tap to the water main and shall install the service line from the water main to the Meter Pit. 7.) Service Line from the Meter Pit through to the structure, shall be installed per the Illinois Plumbing Code. 8.) If meters are allowed inside the structure, the meter will NOT be installed during freezing temperatures until heating system is functioning.

9.) Must provide a copy of site plan or aerial photo showing the structure location on lot. 10.) If applicable, meter setting must be complete prior to water meter being installed. Customer must notify Aqua Illinois, Inc.'s Customer Service at 877-***-**** when system is ready for a meter installation. No water shall be used from service line without meter being installed.

11.) Upon receipt and approval of this form by Aqua, please allow up to four weeks for installation of the water service. There are three ways to get your signed document to Aqua Illinois, Inc.'s office:

E-mail to: ***************@***********.*** as a PDF or XPS file. These forms can be electronically signed. (preferred method)

Fax it to 815-***-**** (Attention: New Services), also make sure to include all the pages.

Mail it to Aqua Illinois, Inc. @ 1000 S Schuyler Avenue, Kankakee, IL 60901 (Attention: New Services) 12.) The water service connection will not be scheduled for installation until this completed document has been received and approved by Aqua. If you have any questions please call 877-***-****. 13.) If water is needed before the water service is installed, Aqua has a Hydrant Meters Rental program that can be used between the months of April through November, for a deposit of $1,200.00. The deposit will be refunded once the hydrant meter has been returned in good condition.

14.) If a Private Fire Service Line (PFSL) is required, the domestic service connection shall be made from the PSFL per the Illinois Department of Public Health (IDPH) requirements. In the event IDPH requirements change in the future, the customer shall be responsible to install a new, separate domestic service line and disconnect the domestic service from the PFSL in accordance with Aqua policy. IX)

1.) Wastewater services shall be made to sanitary sewer pipes and will not be made to structures. 2.) Aqua will make the tap to the sanitary sewer pipe and the customer shall install their service line to the Aqua connection. The customer is responsible for connecting the service line to the Aqua tap on the sanitary sewer main. 3.) The customer shall provide a clean-out at the property line and a clean-out within five feet from the point where the service line leaves the structure. Both clean-outs shall have screw down lids and shall be located a minimum of two inches above the surrounding grade.

4.)

5.)

X) DRAWING

1.) Must provide a copy of an approved site plan or aerial photograph showing the structure location on the lot. XI) Service Plant Fund

1.) The water plant fund fee must be paid prior to Aqua setting a schedule for meter or service installation. Once the application has been reviewed, the Applicant will be contacted with instructions for payment. 2.) The wastewater plant fund fee must be paid prior to Aqua setting a schedule for the service line connection. Once the application has been reviewed, the Applicant will be contacted with instructions for payment. XII) Installation Date:

The billing for the Water Service begins from the date Aqua installs the Service line. The billing for the Wastewater Service begins from the date the customer connects the Service line. Aqua will make every effort to install the water service or tap the sanitary sewer as close to the date requested as possible. Date Service needed :

XIII) I have read and agree to all provisions in this “Application for RESIDENTIAL SERVICE REQUEST". Signature Date

(Signature Required)

Print Name

INSTRUCTIONS AND CONDITIONS FOR WASTEWATER SERVICE INSTALLATION: The customer shall install a six-inch service line between the sanitary sewer main and the clean-out near the property line. Sanitary sewer service lines shall have gasketed joints. Glued sanitary sewer service lines shall not be allowed. Rev: Mar-2019 Application for Service Page 2 of 3

Water Supply Fixture Unit Calculation

FIXTURE EXISTING

QUANTITY

PROPOSED

ADDITIONAL

QUANTITY

FIXTURE UNITS TOTAL

Water Closet (toilet) + x 3

Lavatory (bathroom sink) + x 2

Bathtub + x 4

Shower Stall + x 3

Kitchen Sink + x 4

Laundry Tray + x 3

Dishwashing Machine + x 1

Laundry Machine + x 3

Other: + x

Other: + x

GRAND TOTAL:

Fixture Unit Calculation By:

General Notes:

All rough in plumbing must be included.

Do not count sill cocks, hose bibs.

Irrigation calcs as provided by plumber

An increase of total fixture units may require an up-sizing of the water service line and/or water meter to be in compliance with Illinois Plumbing Code Section 890, Appendix A-Tables M, N and 0. Print Name Title Date

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