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Application for Bulk Water

  1. City of Delafield Water Utility

    500 Genesee St Delafield WI 53018 Phone: (262)-646-6220

  2. Application for the Use of Bulk Water

  3. Location and Number of Hydrant: Milwaukee & Crossroads Court, E-9

  4. USE OF BULK WATER IS SUBJECT TO THE FOLLOWING CHARGES:

  5. The following charges shall apply:*

    If you are unsure about the minimum/ payment due at this time, please call 262-646-6220

  6. • The $25.00 service charge and the $10.00 minimum charge for water usage must be filed with this application. • At the completion of use, applicant must call in the number of gallons used and will be billed accordingly. The applicant will be billed at the current water rate schedule for water used with a minimum charge of $10.00. The current rate is $3.25 per 1,000. If the usage does not exceed the $10.00 minimum there will be no billing. If the usage exceeds the $10.00 minimum the minimum will be removed from the total and billed accordingly. • The Water Utility reserves the right to schedule the period of use and time of the water supply and may interrupt the service as necessary. • Refunds of deposits will be made upon return of the utility equipment and inspection of by the Superintendent. Damaged or lost equipment will be repaired or replaced at the customer’s expense. • The applicant is further subject to the General Rules and Regulations of the City of Delafield Water Utility.

  7. BY SUBMITTING THIS FORM I ACKOWLEDGE THAT THE VEHICLE/TANK IS EQUIPPED WITH AN AIR GAP

  8. ** REMOVE CONNECTION FROM TANK TO HYDRANT WHEN NOT IMMEDIATELY TAKING WATER**

  9. By submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the City of Delafield

  10. Authorized Signature- Water Utility

  11. Leave This Blank:

  12. This field is not part of the form submission.