Fillable Water & Sewer Service Application (Village of Round Lake Beach)

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Water & Sewer Service Application (Village of Round Lake Beach)

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The Water & Sewer Service Application (Village of Round Lake Beach) form is 1 page long and contains:

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  • 0 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Round Lake Beach

BROWSE VILLAGE OF ROUND LAKE BEACH (IL) FORMS

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Village of Round Lake Beach
1937 Municipal Way, Round Lake Beach, Illinois
847-546-2351
www.villageofroundlakebeach.com
Water & Sewer Service Application
Please print legibly.
Customer Name
First Last
Service Address
P.I.N. #
Service City, State ZIP
Daytime Phone Number
Other Phone Number
Bill To Name (if different)
Rental? Y N
Billing Address (if different)
Billing City, State, ZIP
Daytime Phone Number
Other Phone Number
HAZARD CODES TO NOTE ON ACCOUNT: (dog, invisible fence, etc.)
I agree to pay all charges for the furnishing of water and sewer service, as such charges become due and payable, in
accordance with the regulations, rates and fees set forth in all existing and future Village Ordinances which may be in
force. Tenant and Owner are jointly and severally liable to pay for the service.
Signature
Date
For Office Use Only
Account Number
Route:
Services Provided: Water Sewer
$100 Deposit (Cash, Check #, CC , E-Pay, Lockbox:
Deposit Date:
Waiver signed if off? Y N
Class: Residential or Business
Is the applicant an Owner or Landlord?
Has an occupancy permit been approved?
Date Number
Was final read scheduled by prior owner and completed?
Final Read:
Date
By:
Finance Clerk:
Date Entered:
If any “NO’s,” please get approval of supervisor to proceed.
NOTES:____________________________________________________________________________________________________________________
No
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Water & Sewer Service Application (Village of Round Lake Beach)

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Completed 16 July 2020

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