 Service Application and Agreement [Oct 2008] |
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APPENDIX A
(Sample)
Standard Service Application Packet
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. Box 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Service Application and Agreement
This application and agreement form must be completed and signed only by the person(s) requesting service. For new service, the district may request a map or play showing the applicant’s preferred meter location on the premises.
APPLICANT INFORMATION:
Name: ________________________ DOB: _________________ TDL#:____________________
Name: ________________________ DOB: _________________ TDL#: ____________________
Home Phone: (______) _____________________ Work Phone: (_____) _____________________________
PROPERTY:
Service Address: ______________________________________________________________________________
Street City State Zip
Legal Description [ ] Copy of deed or description attached; or
[ ] Subdivision: ____________________________ Lot: ______ Block: _________________
LANDLORD INFORMATION: (if applicable)
Landlord: ________________________________ Telephone: ( ______) _______________________________
Landlord’s Address: ___________________________________________________________________________
SERVICE INFORMATION:
Proposed Use of Property: [ ] Residential [ ] Agricultural [ ] Commercial [ ] Other
If Commercial or Other, describe: _________________________________________________________________
Acreage: _____________ Building Area: _______ft² Irrigation system? (Y/N): _______ No. of Residents: _____
Livestock (Type & Number): _____________________________________________________________________
Special Service Needs:___________________________________________________________________________
Date Approved: _______________________
Inspection Date: ______________________
Service Date: ________________________
Easement Rec’d: Yes ______ No ________ DISTRICT USE ONLY
Service Class: ________________________
Meter Size: __________________________
Line Extension:_______________________
Road Bore:__________________________
Account No: ________________________
Deposit $___________________________
Connect Fee $_______________________
Date Paid: __________________________
SERVICE APPLICATION AND AGREEMENT (CONT’D)
Upon the undersigned Applicant, singly or collectively, complying with all terms and conditions of service, the Wylie Northeast Special Utility District will furnished water service to Applicant at the above-reference property and Applicant shall purchase and receive water service from the district in accordance with the district’s Rate Order and other applicable service policies, if any. Applicant further agrees to pay all applicable fees and charges for such water service in accordance with district’s Rate Order, as amended from time to time.
All water furnished by the district to Applicant shall be metered by a meter installed, owned, and maintained by the district. The district shall have the exclusive right to locate the mater meter, pipeline and appurtenant equipment on the property to connect Applicant to the district’s water system. The meter and service connection is for the sole use of Applicant and is to provide service to only one( 1) dwelling or (1) business on the property. Applicant shall allow the district access to the district’s meter, pipeline and appurtenant equipment on the property at all times for any purpose connected with, or in the furtherance of, the district’s water utility operations. In addition, the district shall have the right to enter upon the property and remove its meter, pipeline or appurtenant equipment upon disconnection or discontinuance of service to Applicant. Applicant is expressly prohibited from (i) attempting to tamper with or bypass the meter (ii) diverting water service from the property to another tract or parcel of land, or (iii) sharing, reselling or sub metering water to any other person, dwelling, business or property. Ay person who intentionally or knowingly causes impairment or interruption of the district’s public water supply, or causes it to be diverted in any manner, shall be reported by the district for possible prosecution under Texas Penal Code §28.03.
Applicant shall install, at Applicant’s own expenses, any necessary service lines from the district’s meter to the point of use including customer service isolation valves, backflow prevention devices, clean-outs and other equipment as may be specified by the district.
Water service proved to Applicant by the district shall be provided for the use indicated on the front of this application form (i.e. residential, commercial, etc.) Applicant must notify the district prior to converting the service address to another use (for example converting a residence to a business) by completing a new Service Application and Agreement. Additional fee may be required.
As a condition of service, Applicant shall grant to the district, now or in the future, any easement and right-of-way required by the district for the purpose of installing, maintaining, or operating the district’s water distribution facilities, including pipelines, meters, valves and hydrants, that the district deems necessary to extend or improve service for existing or future customers. The grant shall be on a form approved by the district.
The district is responsible for protecting the public drinking water supply from contamination or pollution. The following unacceptable practices are prohibited by state regulations:
(a) No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate backflow prevention assembly in accordance with state regulations.
(b) No cross connection between the public drinking water supply and a private water system is permitted. Such threats to the public drinking water supply shall be eliminated at the service connection by the proper installation of an air gap or a reduced pressure zone backflow prevention assembly, and must include a service agreement for annual inspection and testing by a certified backflow prevention device tester.
(c) No connection which allows condensing, cooling, or industrial process water to be returned to the public water supply is permitted.
(d) No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
No colder or flux that contains more than 0.2% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
Applicant shall allow the property receiving service to be inspected for possible cross-connections, potential contamination hazards and illegal lead materials. These inspections shall be conducted by the district or its designated agent prior to initiating service and periodically thereafter. The district shall notify Applicant in writing of any cross-connections or other undesirable practices which have been identified during the initial or subsequent inspection. Applicant shall immediately correct any undesirable practice on their premises and shall, at Applicant’s own expense, properly install, test and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Applicant.
If Applicant fails to com ply with the terms of this service agreement, the district shall, at its option, either terminate service or properly install test, and maintain an appropriate backflow prevention device at the service connection. Notwithstanding anything to the contrary, the district may immediately disconnect service without prior notice if an actual health hazard exists. Any expenses associated with the enforcement of this service agreement shall be billed to the customer.
By execution hereof, the Application shall hold the District harmless from any and all claims for damages caused by service interruptions due to waterline breaks by utility or contractors, tampering by other district customers, normal failures of the system. Or other events beyond the District’s control. Applicant also acknowledges that the district’s water system provides potable water for domestic consumption only and the district does not guarantee that its water system will provide “fire Flows” as defines by the Uniform Code or similar code to fight structure fires.
Any misrepresentation of facts by Applicant in this service agreement shall result in the district disconnecting service to Applicant in accordance with the district’s Rated Order. The district shall maintain a copy of this service agreement as long as the Applicant and/or premises is connected to the district’s public water system.
AGREED TO BY APPLICANT:
_______________________________________ _______________________________________
Applicant Signature Applicant Signature
Application received on behalf of district by _____________________on __________________, 20____.
REQUEST FOR CONFIDENTIALITY
You can now request that personal information contained in district customer/account records not be released to unauthorized persons. Under Section 182-052 of the Texas Utility Code, the district may not disclose personal information in a customer’s account record, or any information relating to water usage or billing, if the customer requests in writing that the information be kept confidential.
Please note, the district must still provide this information under law to certain persons.
The district must still provide this information to: (1) an official or employee of the state or a political subdivision of the state, or the federal government acting in an official capacity; (2) an employee of a utility acting in connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by, and providing services to, the district or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government; (5) a person for whom the Applicant has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas electricity, or drainage service for compensation.
I/we hereby request that the district keep the personal information in my/our account record confidential, including address, telephone number and social security number(s), to the extent permitted by federal and state law.
_____________________________________ Date: ________________________
Signature
_____________________________________ Date: ________________________
Signature
AFTER RECORDING RETURN TO:
Wylie Northeast SUD
P.O. Box 1029
Wylie, Texas 75098
EASEMENT AND RIGHT-OF-WAY
(Including Temporary Easement for Construction)
STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF COLLIN §
That (hereinafter individually or collectively “Grantor”), residing at , but own said property, with the service description of . for and in consideration of ONE DOLLAR AND NO/100 ($1.00) and other good and valuable consideration paid to Grantor by the Wylie Northeast Special Utility District (hereinafter “Grantee”), the receipt and sufficiency of which is hereby acknowledged, does hereby grant and convey unto Grantee, its successors and assigns, a permanent easement and right-of-way to erect, construct, install and lay, and there after access and use, operate, inspect, repair, alter, protect, maintain, replace, upgrade, parallel, add, and remove water distribution lines and appurtenances and any other facilities necessary to serve Grantor’s property as well as Grantee’s current and future system-wide water utility customers, under, over and across -0-acres of land, more particularly described in an instrument recorded in MIN or MIERS: of the Real Property Records of Collin County, Texas, together with the right of ingress, egress, and regress over Grantor’s adjacent lands for the purpose for which the above mentioned rights are granted. The easement hereby granted shall not exceed twenty feet (20’) in width, and Grantee is hereby authorized to designate the course of the easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as installed.
Grantor also grants and conveys unto Grantee a thirty foot (30’) wide temporary construction easement for use in connection with the initial installation of a pipeline or lines by Grantee in the in the permanent easement described herein above, and for the storage of excavation material resulting from such construction. Grantee is hereby authorized to designate the course of the temporary construction easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land thirty foot (30’) in width the center line thereof being the pipeline as installed. The temporary construction easement will expire upon completion of construction and acceptance of the pipeline or lines by Grantee.
Grantee shall have such other rights and benefits necessary and/or convenient for the full enjoyment and use of the rights herein granted, including without limitation; (I) the reasonable right of ingress and egress over and across lands owned by Grantor which are contiguous to easement; (II) the reasonable right from time-to-time to remove any and all paving, trees and undergrowth, and other obstructions that may injure Grantee’s pipelines, appurtenances and facilities, or interfere with the construction, installation, use operation, inspection, repair, alteration, protection, maintenance, replacement, upgrading, paralleling or removal thereof; and (III) the right to abandon-in-place any and all pipelines, appurtenances and facilities, such that Grantee shall have no obligation or liability to Grantor or to Grantor’s heirs, successors or assigns, to move or remove any such abandoned pipelines, appurtenances or facilities.
In the event the easement hereby granted abuts on a public road and the county or state hereafter widens or relocates the public road so as to require the relocation of this water line as installed, Grantor further grants to Grantee an additional easement over and across the land described above for the purpose of laterally relocating said pipeline as may be necessary to clear the road improvements, which easement hereby granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as relocated.
Grantor, and Grantor’s heirs, successors and assigns, may fully use and enjoy the premises encumbered by said easement, except that such use and enjoyment shall not hinder, conflict or interfere with the exercise of Grantee’s rights hereunder and no building, structure or reservoir shall be constructed upon, over or across the easement hereby granted without Grantee’s written consent; provided further that Grantor, and Grantor’s heirs, successors and assigns, may construct, dedicate and maintain over and across the easement such driveways, utility lines and fences as will not interfere with Grantee’s use of the easement for the purpose aforesaid.
The consideration recited herein shall constitute payment in full for all damages sustained by Grantor by reason of the installation of the pipelines, appurtenances and facilities referred to herein, and the Grantee will maintain such easement in a state of good repair and efficiency so that no unreasonable damages will result from its use to Grantor’s premises. This agreement together with other provisions of this grant shall be perpetual and shall constitute a covenant running with the land for the benefit of the Grantee, its successors and assigns. Grantee’s rights hereunder may be assigned in whole or in part to one or more assignees. Grantor covenants that Grantor is the owner of the above described land and that said land is free and clear of all encumbrances and liens.
TO HAVE AND TO HOLD the easement and rights appurtenant thereto unto the Grantee, its successors and assigns, until the pipelines, appurtenances and facilities are declared permanently abandoned by the Grantee, in which event said easement and rights appurtenant there to shall cease and terminate and revert to Grantor, Grantor’s successors and assigns.
Grantor does hereby bind itself and Grantor’s heirs, successors and assigns, to WARRANT AND FOREVER DEFEND, all and singular, the easement and rights appurtenant thereto herein granted to Grantee, its successors and assigns, against every person whomsoever claiming, or to claim, the same or any part thereof.
It is expressly understood that all rights, conveyances or covenants are herein written, and no verbal agreements of any kind shall be binding or recognized or in any way modify this instrument of conveyance.
When context requires, singular nouns and pronouns include the plural.
GRANTORS:
____________________________ ___________________________________
Signature or Party 1 Signature of Party 2
_____________________________ ____________________________________
Printed name of Party 1 Printed name of Party 2
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
____________________________________
Notary Public, State of Texas
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
Notary Public, State of Texas
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Residential Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Deposit . . . . . . $ 200.00
Activation Fee . . . . . . $ 75.00
Connection Fee . . . . . . . $ 2,450.00
Reserved Service Charge . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature :_______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheastwater.com
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Commercial Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Service Investigation Fee . . . . . $ _______
Activation Fee . . . . . . $ 75.00
Deposit. . . . . . . . $ _______
Connection Fee . . . . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature: _______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheasttwater.com
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| APPENDIX A (Sample) Standard Service Application Packet [2008] |
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APPENDIX A
(Sample)
Standard Service Application Packet
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. Box 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Service Application and Agreement
This application and agreement form must be completed and signed only by the person(s) requesting service. For new service, the district may request a map or play showing the applicant’s preferred meter location on the premises.
APPLICANT INFORMATION:
Name: ________________________ DOB: _________________ TDL#:____________________
Name: ________________________ DOB: _________________ TDL#: ____________________
Home Phone: (______) _____________________ Work Phone: (_____) _____________________________
PROPERTY:
Service Address: ______________________________________________________________________________
Street City State Zip
Legal Description [ ] Copy of deed or description attached; or
[ ] Subdivision: ____________________________ Lot: ______ Block: _________________
LANDLORD INFORMATION: (if applicable)
Landlord: ________________________________ Telephone: ( ______) _______________________________
Landlord’s Address: ___________________________________________________________________________
SERVICE INFORMATION:
Proposed Use of Property: [ ] Residential [ ] Agricultural [ ] Commercial [ ] Other
If Commercial or Other, describe: _________________________________________________________________
Acreage: _____________ Building Area: _______ft² Irrigation system? (Y/N): _______ No. of Residents: _____
Livestock (Type & Number): _____________________________________________________________________
Special Service Needs:___________________________________________________________________________
Date Approved: _______________________
Inspection Date: ______________________
Service Date: ________________________
Easement Rec’d: Yes ______ No ________ DISTRICT USE ONLY
Service Class: ________________________
Meter Size: __________________________
Line Extension:_______________________
Road Bore:__________________________
Account No: ________________________
Deposit $___________________________
Connect Fee $_______________________
Date Paid: __________________________
SERVICE APPLICATION AND AGREEMENT (CONT’D)
Upon the undersigned Applicant, singly or collectively, complying with all terms and conditions of service, the Wylie Northeast Special Utility District will furnished water service to Applicant at the above-reference property and Applicant shall purchase and receive water service from the district in accordance with the district’s Rate Order and other applicable service policies, if any. Applicant further agrees to pay all applicable fees and charges for such water service in accordance with district’s Rate Order, as amended from time to time.
All water furnished by the district to Applicant shall be metered by a meter installed, owned, and maintained by the district. The district shall have the exclusive right to locate the mater meter, pipeline and appurtenant equipment on the property to connect Applicant to the district’s water system. The meter and service connection is for the sole use of Applicant and is to provide service to only one( 1) dwelling or (1) business on the property. Applicant shall allow the district access to the district’s meter, pipeline and appurtenant equipment on the property at all times for any purpose connected with, or in the furtherance of, the district’s water utility operations. In addition, the district shall have the right to enter upon the property and remove its meter, pipeline or appurtenant equipment upon disconnection or discontinuance of service to Applicant. Applicant is expressly prohibited from (i) attempting to tamper with or bypass the meter (ii) diverting water service from the property to another tract or parcel of land, or (iii) sharing, reselling or sub metering water to any other person, dwelling, business or property. Ay person who intentionally or knowingly causes impairment or interruption of the district’s public water supply, or causes it to be diverted in any manner, shall be reported by the district for possible prosecution under Texas Penal Code §28.03.
Applicant shall install, at Applicant’s own expenses, any necessary service lines from the district’s meter to the point of use including customer service isolation valves, backflow prevention devices, clean-outs and other equipment as may be specified by the district.
Water service proved to Applicant by the district shall be provided for the use indicated on the front of this application form (i.e. residential, commercial, etc.) Applicant must notify the district prior to converting the service address to another use (for example converting a residence to a business) by completing a new Service Application and Agreement. Additional fee may be required.
As a condition of service, Applicant shall grant to the district, now or in the future, any easement and right-of-way required by the district for the purpose of installing, maintaining, or operating the district’s water distribution facilities, including pipelines, meters, valves and hydrants, that the district deems necessary to extend or improve service for existing or future customers. The grant shall be on a form approved by the district.
The district is responsible for protecting the public drinking water supply from contamination or pollution. The following unacceptable practices are prohibited by state regulations:
(a) No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate backflow prevention assembly in accordance with state regulations.
(b) No cross connection between the public drinking water supply and a private water system is permitted. Such threats to the public drinking water supply shall be eliminated at the service connection by the proper installation of an air gap or a reduced pressure zone backflow prevention assembly, and must include a service agreement for annual inspection and testing by a certified backflow prevention device tester.
(c) No connection which allows condensing, cooling, or industrial process water to be returned to the public water supply is permitted.
(d) No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
No colder or flux that contains more than 0.2% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
Applicant shall allow the property receiving service to be inspected for possible cross-connections, potential contamination hazards and illegal lead materials. These inspections shall be conducted by the district or its designated agent prior to initiating service and periodically thereafter. The district shall notify Applicant in writing of any cross-connections or other undesirable practices which have been identified during the initial or subsequent inspection. Applicant shall immediately correct any undesirable practice on their premises and shall, at Applicant’s own expense, properly install, test and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Applicant.
If Applicant fails to com ply with the terms of this service agreement, the district shall, at its option, either terminate service or properly install test, and maintain an appropriate backflow prevention device at the service connection. Notwithstanding anything to the contrary, the district may immediately disconnect service without prior notice if an actual health hazard exists. Any expenses associated with the enforcement of this service agreement shall be billed to the customer.
By execution hereof, the Application shall hold the District harmless from any and all claims for damages caused by service interruptions due to waterline breaks by utility or contractors, tampering by other district customers, normal failures of the system. Or other events beyond the District’s control. Applicant also acknowledges that the district’s water system provides potable water for domestic consumption only and the district does not guarantee that its water system will provide “fire Flows” as defines by the Uniform Code or similar code to fight structure fires.
Any misrepresentation of facts by Applicant in this service agreement shall result in the district disconnecting service to Applicant in accordance with the district’s Rated Order. The district shall maintain a copy of this service agreement as long as the Applicant and/or premises is connected to the district’s public water system.
AGREED TO BY APPLICANT:
_______________________________________ _______________________________________
Applicant Signature Applicant Signature
Application received on behalf of district by _____________________on __________________, 20____.
REQUEST FOR CONFIDENTIALITY
You can now request that personal information contained in district customer/account records not be released to unauthorized persons. Under Section 182-052 of the Texas Utility Code, the district may not disclose personal information in a customer’s account record, or any information relating to water usage or billing, if the customer requests in writing that the information be kept confidential.
Please note, the district must still provide this information under law to certain persons.
The district must still provide this information to: (1) an official or employee of the state or a political subdivision of the state, or the federal government acting in an official capacity; (2) an employee of a utility acting in connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by, and providing services to, the district or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government; (5) a person for whom the Applicant has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas electricity, or drainage service for compensation.
I/we hereby request that the district keep the personal information in my/our account record confidential, including address, telephone number and social security number(s), to the extent permitted by federal and state law.
_____________________________________ Date: ________________________
Signature
_____________________________________ Date: ________________________
Signature
AFTER RECORDING RETURN TO:
Wylie Northeast SUD
P.O. Box 1029
Wylie, Texas 75098
EASEMENT AND RIGHT-OF-WAY
(Including Temporary Easement for Construction)
STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF COLLIN §
That (hereinafter individually or collectively “Grantor”), residing at , but own said property, with the service description of . for and in consideration of ONE DOLLAR AND NO/100 ($1.00) and other good and valuable consideration paid to Grantor by the Wylie Northeast Special Utility District (hereinafter “Grantee”), the receipt and sufficiency of which is hereby acknowledged, does hereby grant and convey unto Grantee, its successors and assigns, a permanent easement and right-of-way to erect, construct, install and lay, and there after access and use, operate, inspect, repair, alter, protect, maintain, replace, upgrade, parallel, add, and remove water distribution lines and appurtenances and any other facilities necessary to serve Grantor’s property as well as Grantee’s current and future system-wide water utility customers, under, over and across -0-acres of land, more particularly described in an instrument recorded in MIN or MIERS: of the Real Property Records of Collin County, Texas, together with the right of ingress, egress, and regress over Grantor’s adjacent lands for the purpose for which the above mentioned rights are granted. The easement hereby granted shall not exceed twenty feet (20’) in width, and Grantee is hereby authorized to designate the course of the easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as installed.
Grantor also grants and conveys unto Grantee a thirty foot (30’) wide temporary construction easement for use in connection with the initial installation of a pipeline or lines by Grantee in the in the permanent easement described herein above, and for the storage of excavation material resulting from such construction. Grantee is hereby authorized to designate the course of the temporary construction easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land thirty foot (30’) in width the center line thereof being the pipeline as installed. The temporary construction easement will expire upon completion of construction and acceptance of the pipeline or lines by Grantee.
Grantee shall have such other rights and benefits necessary and/or convenient for the full enjoyment and use of the rights herein granted, including without limitation; (I) the reasonable right of ingress and egress over and across lands owned by Grantor which are contiguous to easement; (II) the reasonable right from time-to-time to remove any and all paving, trees and undergrowth, and other obstructions that may injure Grantee’s pipelines, appurtenances and facilities, or interfere with the construction, installation, use operation, inspection, repair, alteration, protection, maintenance, replacement, upgrading, paralleling or removal thereof; and (III) the right to abandon-in-place any and all pipelines, appurtenances and facilities, such that Grantee shall have no obligation or liability to Grantor or to Grantor’s heirs, successors or assigns, to move or remove any such abandoned pipelines, appurtenances or facilities.
In the event the easement hereby granted abuts on a public road and the county or state hereafter widens or relocates the public road so as to require the relocation of this water line as installed, Grantor further grants to Grantee an additional easement over and across the land described above for the purpose of laterally relocating said pipeline as may be necessary to clear the road improvements, which easement hereby granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as relocated.
Grantor, and Grantor’s heirs, successors and assigns, may fully use and enjoy the premises encumbered by said easement, except that such use and enjoyment shall not hinder, conflict or interfere with the exercise of Grantee’s rights hereunder and no building, structure or reservoir shall be constructed upon, over or across the easement hereby granted without Grantee’s written consent; provided further that Grantor, and Grantor’s heirs, successors and assigns, may construct, dedicate and maintain over and across the easement such driveways, utility lines and fences as will not interfere with Grantee’s use of the easement for the purpose aforesaid.
The consideration recited herein shall constitute payment in full for all damages sustained by Grantor by reason of the installation of the pipelines, appurtenances and facilities referred to herein, and the Grantee will maintain such easement in a state of good repair and efficiency so that no unreasonable damages will result from its use to Grantor’s premises. This agreement together with other provisions of this grant shall be perpetual and shall constitute a covenant running with the land for the benefit of the Grantee, its successors and assigns. Grantee’s rights hereunder may be assigned in whole or in part to one or more assignees. Grantor covenants that Grantor is the owner of the above described land and that said land is free and clear of all encumbrances and liens.
TO HAVE AND TO HOLD the easement and rights appurtenant thereto unto the Grantee, its successors and assigns, until the pipelines, appurtenances and facilities are declared permanently abandoned by the Grantee, in which event said easement and rights appurtenant there to shall cease and terminate and revert to Grantor, Grantor’s successors and assigns.
Grantor does hereby bind itself and Grantor’s heirs, successors and assigns, to WARRANT AND FOREVER DEFEND, all and singular, the easement and rights appurtenant thereto herein granted to Grantee, its successors and assigns, against every person whomsoever claiming, or to claim, the same or any part thereof.
It is expressly understood that all rights, conveyances or covenants are herein written, and no verbal agreements of any kind shall be binding or recognized or in any way modify this instrument of conveyance.
When context requires, singular nouns and pronouns include the plural.
GRANTORS:
____________________________ ___________________________________
Signature or Party 1 Signature of Party 2
_____________________________ ____________________________________
Printed name of Party 1 Printed name of Party 2
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
____________________________________
Notary Public, State of Texas
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
Notary Public, State of Texas
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Residential Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Deposit . . . . . . $ 200.00
Activation Fee . . . . . . $ 75.00
Connection Fee . . . . . . . $ 2,450.00
Reserved Service Charge . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature :_______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheastwater.com
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Commercial Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Service Investigation Fee . . . . . $ _______
Activation Fee . . . . . . $ 75.00
Deposit. . . . . . . . $ _______
Connection Fee . . . . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature: _______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheasttwater.com
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| STANDARD SERVICE APPLICATION PACKET: APPENDIX A [Oct 2008] |
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APPENDIX A
(Sample)
Standard Service Application Packet
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. Box 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Service Application and Agreement
This application and agreement form must be completed and signed only by the person(s) requesting service. For new service, the district may request a map or play showing the applicant’s preferred meter location on the premises.
APPLICANT INFORMATION:
Name: ________________________ DOB: _________________ TDL#:____________________
Name: ________________________ DOB: _________________ TDL#: ____________________
Home Phone: (______) _____________________ Work Phone: (_____) _____________________________
PROPERTY:
Service Address: ______________________________________________________________________________
Street City State Zip
Legal Description [ ] Copy of deed or description attached; or
[ ] Subdivision: ____________________________ Lot: ______ Block: _________________
LANDLORD INFORMATION: (if applicable)
Landlord: ________________________________ Telephone: ( ______) _______________________________
Landlord’s Address: ___________________________________________________________________________
SERVICE INFORMATION:
Proposed Use of Property: [ ] Residential [ ] Agricultural [ ] Commercial [ ] Other
If Commercial or Other, describe: _________________________________________________________________
Acreage: _____________ Building Area: _______ft² Irrigation system? (Y/N): _______ No. of Residents: _____
Livestock (Type & Number): _____________________________________________________________________
Special Service Needs:___________________________________________________________________________
Date Approved: _______________________
Inspection Date: ______________________
Service Date: ________________________
Easement Rec’d: Yes ______ No ________ DISTRICT USE ONLY
Service Class: ________________________
Meter Size: __________________________
Line Extension:_______________________
Road Bore:__________________________
Account No: ________________________
Deposit $___________________________
Connect Fee $_______________________
Date Paid: __________________________
SERVICE APPLICATION AND AGREEMENT (CONT’D)
Upon the undersigned Applicant, singly or collectively, complying with all terms and conditions of service, the Wylie Northeast Special Utility District will furnished water service to Applicant at the above-reference property and Applicant shall purchase and receive water service from the district in accordance with the district’s Rate Order and other applicable service policies, if any. Applicant further agrees to pay all applicable fees and charges for such water service in accordance with district’s Rate Order, as amended from time to time.
All water furnished by the district to Applicant shall be metered by a meter installed, owned, and maintained by the district. The district shall have the exclusive right to locate the mater meter, pipeline and appurtenant equipment on the property to connect Applicant to the district’s water system. The meter and service connection is for the sole use of Applicant and is to provide service to only one( 1) dwelling or (1) business on the property. Applicant shall allow the district access to the district’s meter, pipeline and appurtenant equipment on the property at all times for any purpose connected with, or in the furtherance of, the district’s water utility operations. In addition, the district shall have the right to enter upon the property and remove its meter, pipeline or appurtenant equipment upon disconnection or discontinuance of service to Applicant. Applicant is expressly prohibited from (i) attempting to tamper with or bypass the meter (ii) diverting water service from the property to another tract or parcel of land, or (iii) sharing, reselling or sub metering water to any other person, dwelling, business or property. Ay person who intentionally or knowingly causes impairment or interruption of the district’s public water supply, or causes it to be diverted in any manner, shall be reported by the district for possible prosecution under Texas Penal Code §28.03.
Applicant shall install, at Applicant’s own expenses, any necessary service lines from the district’s meter to the point of use including customer service isolation valves, backflow prevention devices, clean-outs and other equipment as may be specified by the district.
Water service proved to Applicant by the district shall be provided for the use indicated on the front of this application form (i.e. residential, commercial, etc.) Applicant must notify the district prior to converting the service address to another use (for example converting a residence to a business) by completing a new Service Application and Agreement. Additional fee may be required.
As a condition of service, Applicant shall grant to the district, now or in the future, any easement and right-of-way required by the district for the purpose of installing, maintaining, or operating the district’s water distribution facilities, including pipelines, meters, valves and hydrants, that the district deems necessary to extend or improve service for existing or future customers. The grant shall be on a form approved by the district.
The district is responsible for protecting the public drinking water supply from contamination or pollution. The following unacceptable practices are prohibited by state regulations:
(a) No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate backflow prevention assembly in accordance with state regulations.
(b) No cross connection between the public drinking water supply and a private water system is permitted. Such threats to the public drinking water supply shall be eliminated at the service connection by the proper installation of an air gap or a reduced pressure zone backflow prevention assembly, and must include a service agreement for annual inspection and testing by a certified backflow prevention device tester.
(c) No connection which allows condensing, cooling, or industrial process water to be returned to the public water supply is permitted.
(d) No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
No colder or flux that contains more than 0.2% lead may be used for the installation or repair of plumbing on or after July 1, 1988 at any connection that provides water for human consumption.
Applicant shall allow the property receiving service to be inspected for possible cross-connections, potential contamination hazards and illegal lead materials. These inspections shall be conducted by the district or its designated agent prior to initiating service and periodically thereafter. The district shall notify Applicant in writing of any cross-connections or other undesirable practices which have been identified during the initial or subsequent inspection. Applicant shall immediately correct any undesirable practice on their premises and shall, at Applicant’s own expense, properly install, test and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Applicant.
If Applicant fails to com ply with the terms of this service agreement, the district shall, at its option, either terminate service or properly install test, and maintain an appropriate backflow prevention device at the service connection. Notwithstanding anything to the contrary, the district may immediately disconnect service without prior notice if an actual health hazard exists. Any expenses associated with the enforcement of this service agreement shall be billed to the customer.
By execution hereof, the Application shall hold the District harmless from any and all claims for damages caused by service interruptions due to waterline breaks by utility or contractors, tampering by other district customers, normal failures of the system. Or other events beyond the District’s control. Applicant also acknowledges that the district’s water system provides potable water for domestic consumption only and the district does not guarantee that its water system will provide “fire Flows” as defines by the Uniform Code or similar code to fight structure fires.
Any misrepresentation of facts by Applicant in this service agreement shall result in the district disconnecting service to Applicant in accordance with the district’s Rated Order. The district shall maintain a copy of this service agreement as long as the Applicant and/or premises is connected to the district’s public water system.
AGREED TO BY APPLICANT:
_______________________________________ _______________________________________
Applicant Signature Applicant Signature
Application received on behalf of district by _____________________on __________________, 20____.
REQUEST FOR CONFIDENTIALITY
You can now request that personal information contained in district customer/account records not be released to unauthorized persons. Under Section 182-052 of the Texas Utility Code, the district may not disclose personal information in a customer’s account record, or any information relating to water usage or billing, if the customer requests in writing that the information be kept confidential.
Please note, the district must still provide this information under law to certain persons.
The district must still provide this information to: (1) an official or employee of the state or a political subdivision of the state, or the federal government acting in an official capacity; (2) an employee of a utility acting in connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by, and providing services to, the district or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government; (5) a person for whom the Applicant has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas electricity, or drainage service for compensation.
I/we hereby request that the district keep the personal information in my/our account record confidential, including address, telephone number and social security number(s), to the extent permitted by federal and state law.
_____________________________________ Date: ________________________
Signature
_____________________________________ Date: ________________________
Signature
AFTER RECORDING RETURN TO:
Wylie Northeast SUD
P.O. Box 1029
Wylie, Texas 75098
EASEMENT AND RIGHT-OF-WAY
(Including Temporary Easement for Construction)
STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF COLLIN §
That (hereinafter individually or collectively “Grantor”), residing at , but own said property, with the service description of . for and in consideration of ONE DOLLAR AND NO/100 ($1.00) and other good and valuable consideration paid to Grantor by the Wylie Northeast Special Utility District (hereinafter “Grantee”), the receipt and sufficiency of which is hereby acknowledged, does hereby grant and convey unto Grantee, its successors and assigns, a permanent easement and right-of-way to erect, construct, install and lay, and there after access and use, operate, inspect, repair, alter, protect, maintain, replace, upgrade, parallel, add, and remove water distribution lines and appurtenances and any other facilities necessary to serve Grantor’s property as well as Grantee’s current and future system-wide water utility customers, under, over and across -0-acres of land, more particularly described in an instrument recorded in MIN or MIERS: of the Real Property Records of Collin County, Texas, together with the right of ingress, egress, and regress over Grantor’s adjacent lands for the purpose for which the above mentioned rights are granted. The easement hereby granted shall not exceed twenty feet (20’) in width, and Grantee is hereby authorized to designate the course of the easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as installed.
Grantor also grants and conveys unto Grantee a thirty foot (30’) wide temporary construction easement for use in connection with the initial installation of a pipeline or lines by Grantee in the in the permanent easement described herein above, and for the storage of excavation material resulting from such construction. Grantee is hereby authorized to designate the course of the temporary construction easement herein conveyed, except that when the first pipeline is installed, the easement herein granted shall be limited to a strip of land thirty foot (30’) in width the center line thereof being the pipeline as installed. The temporary construction easement will expire upon completion of construction and acceptance of the pipeline or lines by Grantee.
Grantee shall have such other rights and benefits necessary and/or convenient for the full enjoyment and use of the rights herein granted, including without limitation; (I) the reasonable right of ingress and egress over and across lands owned by Grantor which are contiguous to easement; (II) the reasonable right from time-to-time to remove any and all paving, trees and undergrowth, and other obstructions that may injure Grantee’s pipelines, appurtenances and facilities, or interfere with the construction, installation, use operation, inspection, repair, alteration, protection, maintenance, replacement, upgrading, paralleling or removal thereof; and (III) the right to abandon-in-place any and all pipelines, appurtenances and facilities, such that Grantee shall have no obligation or liability to Grantor or to Grantor’s heirs, successors or assigns, to move or remove any such abandoned pipelines, appurtenances or facilities.
In the event the easement hereby granted abuts on a public road and the county or state hereafter widens or relocates the public road so as to require the relocation of this water line as installed, Grantor further grants to Grantee an additional easement over and across the land described above for the purpose of laterally relocating said pipeline as may be necessary to clear the road improvements, which easement hereby granted shall be limited to a strip of land twenty feet (20’) in width the center line thereof being the pipeline as relocated.
Grantor, and Grantor’s heirs, successors and assigns, may fully use and enjoy the premises encumbered by said easement, except that such use and enjoyment shall not hinder, conflict or interfere with the exercise of Grantee’s rights hereunder and no building, structure or reservoir shall be constructed upon, over or across the easement hereby granted without Grantee’s written consent; provided further that Grantor, and Grantor’s heirs, successors and assigns, may construct, dedicate and maintain over and across the easement such driveways, utility lines and fences as will not interfere with Grantee’s use of the easement for the purpose aforesaid.
The consideration recited herein shall constitute payment in full for all damages sustained by Grantor by reason of the installation of the pipelines, appurtenances and facilities referred to herein, and the Grantee will maintain such easement in a state of good repair and efficiency so that no unreasonable damages will result from its use to Grantor’s premises. This agreement together with other provisions of this grant shall be perpetual and shall constitute a covenant running with the land for the benefit of the Grantee, its successors and assigns. Grantee’s rights hereunder may be assigned in whole or in part to one or more assignees. Grantor covenants that Grantor is the owner of the above described land and that said land is free and clear of all encumbrances and liens.
TO HAVE AND TO HOLD the easement and rights appurtenant thereto unto the Grantee, its successors and assigns, until the pipelines, appurtenances and facilities are declared permanently abandoned by the Grantee, in which event said easement and rights appurtenant there to shall cease and terminate and revert to Grantor, Grantor’s successors and assigns.
Grantor does hereby bind itself and Grantor’s heirs, successors and assigns, to WARRANT AND FOREVER DEFEND, all and singular, the easement and rights appurtenant thereto herein granted to Grantee, its successors and assigns, against every person whomsoever claiming, or to claim, the same or any part thereof.
It is expressly understood that all rights, conveyances or covenants are herein written, and no verbal agreements of any kind shall be binding or recognized or in any way modify this instrument of conveyance.
When context requires, singular nouns and pronouns include the plural.
GRANTORS:
____________________________ ___________________________________
Signature or Party 1 Signature of Party 2
_____________________________ ____________________________________
Printed name of Party 1 Printed name of Party 2
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
____________________________________
Notary Public, State of Texas
STATE OF TEXAS §
COUNTY OF _________________ §
This instrument was acknowledged before me on _______________________,
20____, by _____________________________________.
Notary Public, State of Texas
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Residential Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Deposit . . . . . . $ 200.00
Activation Fee . . . . . . $ 75.00
Connection Fee . . . . . . . $ 2,450.00
Reserved Service Charge . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature :_______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheastwater.com
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT
P.O. BOX 1029
745 Parker Road
Wylie, Texas 75098
(972) 442-2075
Fax (972) 429-9413
COST OF SERVICE
(Commercial Service)
APPLICANT: _________________________________________________ DATE: ______________________
PROPERTY:__________________________________________________________________________________
The district has determined the cost for providing residential water service to your property in the amount stated below. By signing this cost of service notice, you acknowledge that all charges and fees for service are non-refundable except for the deposit. Prior to selling or vacating the property, you must request that your service be discontinued and provide a forwarding address. The district will refund the balance of your deposit after applying any outstanding service charges. This notice is provided in accordance with Section 5.03(e) of the district’s Rate Order and shall remain effective for thirty (30) days from the date above.
Fill-in All fees or charges that apply:
Service Investigation Fee . . . . . $ _______
Activation Fee . . . . . . $ 75.00
Deposit. . . . . . . . $ _______
Connection Fee . . . . . . . . . $ _______
Easement Fee . . . . . . $ _______
Cost of Road Bore . . . . . $ _______
Cost of Line Extension . . . . . $ _______
Other: _______________________________________. . . . . . $ _______
TOTAL: $ _______
RECEIVED BY APPLIANT(S):
Applicant’s Signature: _______________________________________DL # _________________________
Co-Applicant’s Signature: ___________________________________DL # __________________________
Cost of Service Notice (Residential) – Page 1
www.wylienortheasttwater.com
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| Gallonage Charge [Oct 2008] |
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| Gallonage Charge.
A gallonage charge shall be billed at the rate specified in Section 7.07 and shall be calculated in one thousand (1000) gallon increments. Charges for water usage are based on monthly meter readings and are calculated from reading date to reading date. The district shall take all meter readings used in calculating billing |
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| Pay Online |
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| You may now pay your water bill online with your credit card. Your monthly bill will be sent to your email address if this is a service you wish to particpate. This service costs $2. |
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| FINAL ACCEPTANCE BY DISTRICT [Oct 2008] |
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| ACCEPTANCE BY DISTRICT
The District, through its designated representative, hereby agrees to accept the Transferred Properties, and shall hold Developer harmless from this day forward for any costs of repair or maintenance, notwithstanding any warranty, contract or bond for said repairs pursuant to the Contract or this instrument.
WYLIE NORTHEAST SPECIAL UTILITY DISTRICT:
By: _______________________________
President
STATE OF TEXAS §
COUNTY OF COLLIN §
This instrument was acknowledged before me on __________, 20___, by ___________________ as President of Wylie Northeast Special Utility District.
_________________________________
Notary Public, State of Texas
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| FINAL ACKNOWLEDGMENT OF EASEMENT DENIAL [Oct 2008] |
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| FINAL ACKNOWLEDGMENT OF EASEMENT DENIAL
STATE OF TEXAS §
COUNTY OF COLLIN §
Legal Description of Property: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I, _________________________________________________________, owner of the above-described property, hereby refuse and deny the request of Wylie Northeast Special Utility District for an easement and right-of-way to install, extend, enlarge, upgrade, improve or relocate one or more water lines with appurtenances for a community water distribution system upon, under or across the above-described property.
Signature of Property Owner
STATE OF TEXAS §
COUNTY OF COLLIN §
This instrument was acknowledged before me on _______________________, 20___,
by ___________________ .
Notary Public, State of Texas
AFFIDAVIT OF EASEMENT DENIAL
STATE OF TEXAS §
COUNTY OF COLLIN §
Legal Description of Property:
(the "Property").
BEFORE ME, the undersigned Notary Public, on this day personally appeared _________________________, who, after being duly sworn, stated under oath that he/she is the duly appointed General Manager of Wylie Northeast Special Utility District (the "District"); that the District requested easement and right-of-way upon, under and across the Property from _________________________ to install, extend, enlarge, upgrade, improve or relocate one or more water lines with appurtenances for a community water distribution system; that attached to this Affidavit is a true copy of the final easement request letter and Easement and Right-of-Way sent by first class mail, postage prepaid, and certified mail, return receipt requested, to _________________________ on __________________, 20___, and [a signed receipt verifying delivery and acceptance is attached to this Affidavit (OR) the return noting refusal to accept or verify delivery is attached to this Affidavit]; that the District did not receive a signed Easement and Right-of-Way or signed Acknowledgment of Easement Denial within thirty (30) days following the receipt of same by _________________________; that the District’s consulting engineer furnished _________________________ with a current estimate of the cost for relocating, replacing or constructing water distribution facilities and/or other improvements within the requested easement, a true copy of which is attached hereto and incorporated herein; that a copy of this Affidavit will be maintained in the official records of the District; and that every statement contained in this Affidavit is within his/her personal knowledge and is true and correct.
________________________________________
AFFIANT
SUBSCRIBED AND SWORN TO BEFORE ME on the ____ day of _____________, 20___, by _______________________, to certify which witness my hand and official seal.
__________________________________
Notary Public, State of Texas
ACKNOWLEDGED
STATE OF TEXAS §
COUNTY OF COLLIN §
This instrument was acknowledged before me on the ____ day of _____________, 20___, by __________________________ as General Manager of Wylie Northeast Special Utility District.
___________________________________
Notary Public, State of Texas
AFTER RECORDING RETURN TO:
Wylie Northeast SUD
Attn: General Manager
P.O. Box 1029
Wylie, Texas 75098
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| FINAL AFFIDAVIT OF PAYMENT OF LABOR AND MATERIAL FOR IMPROVEMENTS [Oct 2008] |
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| (SAMPLE)
[This form may be used in lieu of a payment bond on contracts of $25,000 or less]
Project No._______________________ _
Contract No. ____________________
OWNER'S AND CONTRACTOR'S AFFIDAVIT OF
PAYMENT OF LABOR AND MATERIAL FOR IMPROVEMENTS
STATE OF TEXAS §
COUNTY OF COLLIN §
THAT pursuant to the provisions of that certain Three-Way Contract entered into on the ____ day of ________________________, 20____, between ________________________ (designated therein and referred to herein as "Owner"), ________________________, (designated therein and referred to herein as "Contractor"), and the Wylie Northeast Special Utility District, Owner and Contractor hereby submit this affidavit, and state under oath, the following:
"That all contractors, subcontractors and other persons who provided labor or furnished materials in connection with the construction of the 'Improvements', as designated in said Three-Way Contract, have been paid in full and that there are no claims, liens, or encumbrances existing against said Improvements, or the land to which they are affixed."
OWNER:
By: ________________________________________
Name: ________________________________________
Title: ________________________________________
Company: _____________________________________
CONTRACTOR:
By: _______________________________________
Name: _______________________________________
Title: _______________________________________
Company: ________________________________
STATE OF TEXAS §
§
COUNTY OF ____ §
SUBSCRIBED AND SWORN TO BEFORE ME this____ day of ___________________,
20____ , by____________________ as__________________________ of __________________ , the Owner.
______________________________________
Notary Public, State of Texas
STATE OF TEXAS §
§
COUNTY OF ____ §
SUBSCRIBED AND SWORN TO BEFORE ME this __ day of _____________________,
20____ , by _________________________ as _______________________ of ____________________ , the Contractor.
_______________________________________
Notary Public, State of Texas
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 Your Water |
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| Residents who live within the boundaries of the Wylie Northeast Special Utility District receive their water from Lake Lavon. |
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| High water quality is a valuable resource. The quality of water used for drinking, cooking and agriculture directly affects public health, safety, and welfare. Wylie Northeast Special Utility District is dedicated to providing clean, pure water. The district continues to provide water system facilities to meet current and future needs, treatment and testing to ensure high quality water. |
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