Water/Sewer/Sanitation Service Application

"*" indicates required fields

Step 1 of 2

Name*

First Last

Certain information can only be released to the individual name on the account. If you would like more than one name on your account, please provide all names, signatures and drivers’ license copies.

Add a second name?*

Yes

Name

First Last

Add a third name?*

Yes

Name

First Last

Phone for main contact*

Email for main contact*

Enter Email Confirm Email

Service Address*

Street Address City State ZIP Code

Billing Address (if different than service address)

Street Address City State ZIP Code

Previous Home Address*

Street Address City State ZIP Code

A COPY OF THE APPLICANT'S DRIVER'S LICENSE IS REQUIRED FOR OUR FILES.
It can be scanned and the file uploaded at the bottom of this form.

Employer*

Work Phone*

Emergency Phone*

Have you had water service in Ball Ground before?*

Yes

When?*

Resident Status:*

Own

Lease

Rent

Name of Owner

Owner's Phone

Address of Owner*

Non Homeowner Refundable Deposit:

Total Due:

Service Fee:

Amount Paid:

Water capacity fee:

Date Paid:

Sewer Tie-in:

Date water service to begin:

Meter Reading:

The City of Ball Ground provides mandatory solid waste services at a rate of $22.00/month per customer. This service is billed with water.

Start date:

The City of Ball Ground Water and Sewer System shall be held harmless of any propertydamage during sanitation service. The City of Ball Ground employees or contractors shall havefree access to any and all property necessary to fulfill service.

Applicant Signature(s)*

Date:

Water System Representative

Upload scan of Driver's License for each applicant

Drop files here or

Max. file size: 32 MB, Max. files: 3.

If you do not have a way to scan your drivers license, you can continue with this online form but you will have to go to the City of Ball Ground offices and let them make a copy before this application will be accepted.

City of Ball Ground Water and Sewer System
Herein referred to as “The System” Water bills are mailed on the last working day of each month, and are payable on or before the 15th of the following month. If for any reason the bill is not paid on or before the 15th, there will be a late fee of 15% assessed. ALL PAST DUE ACCOUNTS ARE SUBJECT TO IMMEDIATE DISCONNECTION OF SERVICE~NO FURTHER NOTICE WILL BE SENT. If service is disconnected, a fee of $50.00 in addition to the delinquent bill will be required to resume service. While not guaranteed, if reconnect is approved for after hours, weekend, or a holiday, a fee of $200.00 will be charged in addition to the delinquent bill to resume service after normal business hours. Also, any unpaid balances may be turned over to collections after 30 days. The customer will be responsible for any fees incurred by the City for collection of the delinquent account and any charges of the collection agency. Failure to receive a bill will not excuse you from making a timely payment. If you fail to receive a bill, please call City Hall at 770-735-2123 for your balance due. The City of Ball Ground reserves the right to change the billing due date.

The fee for NSF checks written to the City of Ball Ground is $30.00.

If at any time a meter that has been locked due to non-payment or misuse during a watering ban, is tampered with, or has the lock removed, there will be an additional fee of $100.00 assessed in addition to all other fees or charges. A second offense of tampering with a locked meter will result in the meter being removed, and a fee of $500.00 will be required for re-installation, in addition to all other fees or charges that may be due on the meter is damaged as a result of the tampering, a new meter must be purchased at the rate established by Mayor and Council plus all other fees and charges due on the account.

The System, under direction of the State, County or City, may impose a ban on outside use of water at any time deemed necessary to maintain the health and welfare of all the users on the system. You will be expected to abide by the ban under this policy or other applicable laws or emergency procedures.

Your meter shall serve only your residence or business and under no circumstances shall any other residence or business be allowed to tap into your service. Violation of this requirement may result in the meter being pulled and a fee of $500.00 being assessed against the account.

Fees outlined in this document are subject to change at any time by Mayor and Council.

Signature of Applicant(s)*

Signature of Second Applicant*

Signature of Third Applicant*

Date:*

Water System Representative

Comments

This field is for validation purposes and should be left unchanged.

Water/Sewer/Sanitation Service Application

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