Applying for water and/or sewer service is an essential step for any homeowner or tenant looking to ensure their residence has the vital utilities needed for daily living. The form W 120A serves as the official application process for residents in the Municipal Authority of Westmoreland County to initiate these services. At the heart of this form is the applicant's request for service, whether for a single-family dwelling, duplex, apartment, or for commercial purposes including retail, industrial, and other specified uses. The form not only asks for basic information such as the location of service and applicant details but also dives deeper into the specifics, such as the type of service (existing or new construction) and the class of service needed (residential, commercial, etc.). Additionally, it addresses the need for a security deposit that safeguards the utility from loss, which is subject to refund under the authority's regulations. A crucial aspect of this application is the flexibility it offers; service may be extended temporarily while verification from the owner or landlord is awaited. This inclusive approach signals an understanding of various customer situations, allowing for water service to commence under a wide array of circumstances. Clearly, the W 120A form is more than mere paperwork; it is a comprehensive tool designed to streamline the process of connecting residents and businesses with essential water and sewer services.
| Question | Answer |
|---|---|
| Form Name | Form W 120A |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ApplicationForS ervice mawc application form |
SERVICE NO: ________________ |
Municipal Authority of Westmoreland County |
DATE: ______________________ |
ACCOUNT NO: ____________________ |
Application for Water |
and/or Sewer
Service |
USER __________________ S02 |
I,, request that water service be Initiated at the following location:
Street/Lot/Plan__________________________________________________________ City_______________________________ ZIP _____________
Tax Map Number _______________________________________________________ County ____________________________________________
SERVICE MAY BE EXTENDED TEMPORARILY UNTIL VERIFICATION WITH THE OWNER/LANDLORD IS RECEIVED.
I am the OWNER / TENANT (circle one) of the property listed above. I agree to use the water according to the rules and regulations of the Authority, copies of which are available for public inspection at the Authority Office, and to pay for water service at the above location in accordance with the rules and rates approved by the Municipal Authority of Westmoreland County within fifteen (15) days from the date that I receive the bill.
I further agree that I will complete the information called for within this application. I understand that I may be required to post a security deposit. In the event that I am required to post a security deposit, the amount will be determined by the Municipal Authority to secure the utility from loss. The amount of any security deposit I may be required to post will be refunded in accordance with the rules and regulations of the Municipal Authority of Westmoreland County.
Type of Service
Existing Service
Building Type
Single Family Dwelling
New Construction
Duplex |
Apartment |
Class of Service
Residential
Retail |
Other |
Commercial |
Industrial |
If other, describe: |
_________________________ |
Sanitary Sewer Service |
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Public |
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Are you a new customer? |
Yes |
If public, list Sewer Authority ________________________________________________
No
If No, previous service address:________________________________________________________ City____________________________________
Applicant Information:
Main phone number: ( _______ ) _______ - ________________Cell phone number: ( _______ ) _______ - ____________________
Employer: _______________________________________________________ Work phone number: : ( _______ ) _______ - __________________
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Social Security Number: ________ - _______ - ________ |
Authorized Contact Person __________________________________________ |
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Drivers License # ______________________________ State ____ |
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Spouse Information |
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Name: |
______________________________________________________ Employer: |
__________________________________________________ |
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Work phone number: (______ ) _______ - __________________ |
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In case of Emergency, contact: |
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Name: |
______________________________________________________ |
Phone Number: ( ______ ) _______ - __________________ |
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Address: _________________________________________________ City:____________________________ST: _______ Zip:__________________
Complete billing address if different from service address:
Street:_______________________________________________________ City: ____________________________ ST:_______ Zip: _____________
If TENANT, complete landlord information requested below:
Name: _____________________________________________________ Street: _______________________________________________________
City:____________________________________ State: ___________ Zip: _____________ Phone Number: ( _______ ) ________ - ___________
I represent that the above location is presently capable of accepting water service. I understand that this application is accepted subject to the availability of water at this location.
Applicant’s Signature: X____________________________________________________________ Date: ____________________________
Deposit
Comments/Additional Information: __________________________________________________________________________________________
Documentation Attached: |
Lease |
Personal ID
(rev. 03/29/07) |