Application for the supply of waterWheatland Regional Corporation Address: PO Box 196, 320 Main street, Rockyford, AB T0J 2R0 Phone: 403-325.9972Email: office@wrc-ab.ca

Property Service No: (Office Use Only)

Application fee:

All following rates apply to the period January 2019 to January 2019. Each connection is rated at 0.75 USGPM (4 m3/day). If more flow is required, then a multiplication of the connection is calculated. All cost associated with construction (installation of saddle, excavation, water meter, valves, vaults…etc) will be charged at cost+5%.

Monthly invoice charges will include two charges.

1. Service charge equal to $50 times number of connections2. Consumption Rate equal $4.00 times consumption volume in m3

Example1- If a customer requires 4 m3/day trickle volume, then they will be provided with a connection equivalent to 1. Installation charge is cost+5%. If their monthly consumption is 12 m3, then their monthly invoice is $50 X 1 + 12 X $4 = $98 + GST

Example2- If a customer requires 6 m3/day trickle volume, then they will be provided with a connection equivalent to 2. Installation charge is cost+5%. If their monthly consumption is 120 m3, then their monthly invoice is $50 X 2 + 120 X $4.00 = $580 + GST

Extra length of pipes and/or fittings shall be charged at cost plus 5%. Any land acquisition and right of way shall be charged at cost plus 5%. The monthly charges (service charge and consumption rate) are subject to annual increase beginning of January every year.

Other chargesThese charges are one time fees per occurrence.

Water meter sale, $cost+5% Water Service disconnect, $100 Water Service reconnect, $100 Late payment fees, 1.5% of unpaid amount NSF or returned cheques, $50

Note- Rates are subject to change based on Wheatland Regional Corporation board approval.

Number of Connection selected

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Wheatland Regional CorporationPolicy Reference 2016-001

Property details

Plan: Block: Lot:

Section: Township: Range:

Street Address or County Blue sign Address:

Existing/main water details:

Is there any common water use at the property? Yes No

If YES, please supply details (eg. pool, garden, common hot water system, cooling/air conditioning towers, common laundry, common car washing area…etc)

Date service required:

Does a corporate body exist? Yes No

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Applicant details

Company name: Name:

Mailing Address:

Postal code:

Phone number (Land): Mobile:

Fax: Email:

Date:

Preferred method of approval: Email Mail

Please allow up to 14 working days for approval & ensure you have read & met the conditions attached. For prompt approval email your application to office@wrc-ab.ca.

Development typePlease tick which best describes the metering requirements:

Residential units. ALL to be metered.

Commercial /industrial/Farm. ALL to be metered.

Decision and notes (Office use only):

Approved Not Approved

Decision Date: __________________________________________

Connection date (if approved): ____________________________

Other Notes: ____________________________________________________________________________________________________

Approval Officer: _________________________________________________________________________________________________________

Conditions of connection for the supply of individual check metersWheatland Regional Corporation’s contractor will install all water meters as part of this application only if the following conditions are met:

1. Water Meters Location

WRC must have direct access to all meters at all times

all meters must be located in general access area.

2. Written Permission

the Acceptance Declaration of WRC policy terms and conditions reference 2016-001 must be signed by the Owner/s or Corporate Body Chairperson/Manager. This form must be returned to WRC at the time of application

3. Private Water Meters

only water meters supplied by WRC are to be installed.

4. Plumbing Works

it is the responsibility of the property owner/s or corporate body manager/chairperson and the plumber undertaking the works to ensure all the above conditions and WRC terms and conditions are met.

If the above requirements & conditions are not met, WRC reserves the right not to provide water to the applicant.

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WRC terms and conditions declarationPlease note: A separate declaration for each individually owned facility is required. However, if a Corporate Body exists WRC will accept a letter confirming the Corporate body will comply with the conditions as stipulated on WRC Service and terms and conditions reference 2016-001.

I have read, understood and agree to the ‘terms and conditions’ as stipulated on this application and in the Wheatland Regional Corporation’s service, terms, and conditions document reference 2016-001.

I understand that if any of the requirements are not met, WRC reserves the right to remove all meter details and discontinue the service.

Owner’s signature

Name of property owner/s

Property owner/s signature/s:

OR Owners/corporate/manager

Corporate Body Chairperson Manager:

Chairperson/Manager’s Signature:

Corporate Body No: Contact phone number:

Please note: WRC also requires verification that the signatory is authorised to sign on behalf of the Corporate Body

Important Privacy Notice By completing this form, you are providing personal information to WRC for the primary purpose of WRC providing you with a water supply.

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