Commercial Water Application Form

ST, CHARLES MESA WATER DISTRICT 1397 Aspen Road Pueblo, Colorado 81006 719 542-4380 FAX 719 542-4862

Parcel No. (required)

Date of Application (required)

Plot Plan/Survey (required)

Time of Application (required)

Legal Description/Subdivision (required)

The undersigned hereby makes application for a service connection to the St. Charles Mesa Water District water system. The service connection is for a single family dwelling.

Name of Business (required)

Phone (required)

Type of Commercial/Business Activity to be conducted (required)

If business is such as requires any federal, Colorado or Pueblo County licensing or permitting, copies of each such business license and permit MUST accompany this application.

Service Address (required)

Commercial or Residential? (required)

Commercial

Residential

Primary Contacy's Name

Home Phone

Work Phone

Service Address (required)

Mailing Address (If different) (required)

Size of Tap Desired (required)

Size of Structure to be served (in sq. ft.) (required)

Projected highest Daily water use (in gal.)

Projected highest Monthly water use (in gal.)

Projected average Monthly water use (in gal.) (required)

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