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Applicant Information

Name:*

Address:*

Phone:*

Email:*

Property Information

Property Address (Connection Location):*

Property Owner Name (If Different):

Parcel Number:*

Township:*

Services:*

Fire Suppression*

Type of Service Requested

Type of Service:*

Meter Size (3/4 in. is most common)*

Service Details

Building Type:*

Intended Use (e.g. single-family home, office, restaurant):*

Number of Bedrooms:*

Number of Toilets:*

Contractor/Plumber Information

Company Name:

Contact Name:

Phone:

Supporting Documents (Attach Copies)

Site Plan or Survey

Plumbing Permit (if required)

File upload

Contact Us

For Billing, Usage, and Shut-off Related Questions, Call:

269-637-0700

For Other Questions, Call:

269-637-0737

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