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Apply for Water Service Connection

  1. Instructions
    - The Member Municipality is to submit this application.
    - Complete 1 through sixteen 16.
    - Submit the form.
  2. Please enter the name and phone number of the contact person.
  3. 10. Expected Use Type
  4. 15. Instructions
    - Champlain Water District must be notified at least 3 working days prior to the tap.
    - Tapping materials and procedure must comply with Champlain Water District, Wholesale Department specifications.
  5. 16. Certifications
    I hereby certify that this information is correct to the best of my knowledge and that the connection will be made according to specifications of the Champlain Water District and will be supervised by the Town of:
  6. Leave This Blank:

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