APPLICATION FOR CONNECTION - WATER

(To be submitted in duplicate)

For municipal government use only

Municipality Name & Address:

Municipal Contact: Name, Title, Telephone & Fax No.

GVWD Main:

Size of Connection:

Location: Street name & distance to property line.

Service Area: Please provide a map of the area to be served by the connection showing municipal water mains and other connections to GVWD mains:

Primary Use: Please select one.

R Domestic R Industrial R Other
Service Area Information

Flow in Million litres per Day (mld)

2021

Present

2041

Population
Annual Average
Peak Day
Peak Hour
*Please provide future projections and indicate their dates
Minimum Required HGL:

Maximum Allowable HGL:

(m Geodetic)

(m Geodetic)

Please provide information for existing connections presently feeding service area:

The above application has been approved and the connection will be made accordingly upon request.

Date

Signature

Administrator, Water
(for Corporate Engineer)
FORM NO. 35A-W REV 7/05