Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Customer Information Date Service to Begin *Please allow 24 hours for service to begin.Service Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateBilling Address *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBilling Name *FirstLast(Name should match Driver’s License Information)(Optional) Business NameComplete only if you would like billing to be in the name of a business or corporation. Driver's License State *— Select State —TexasOtherDrivers License Number *Other State *Email *Phone *Spouses Name to be added to account FirstLastSpouse's PhoneOwnership *RentingLeasingOwningIf Renting or Leasing— Please Provide Property Owner Name, Address & Telephone Number *AgreementsI have the following installed at the service address *Irrigation SystemPoolHot TubWater SoftenerI do not have any of these servicesI agree to notify the City of Sunrise Beach if any of the previous items are installed after Service begin date. of the above are noticed at the time of turn on, The City of Sunrise Beach will not turn on services until all requirements are met. *I agreeAgreement *I agree to the following terms of service. I have read the following and acknowledge agreement UTILITY SERVICE APPLICATION & AGREEMENT I. PURPOSE: City of Sunrise Beach is responsible for protecting the drinking water supply from contamination or pollution which could result from improper plumbing practices. The purpose of this Service Agreement is to notify each customer of the plumbing restrictions which are in place to provide this protection. The City utility enforces these restrictions to ensure the public health and welfare. Each customer must sign or acknowledge agreement to this Service Agreement before we begin service. In addition, when service to an existing connection has been suspended or terminated, the water system will not re-establish service unless it has a signed or acknowledged copy of this Service Agreement. II. PLUMBING RESTRICTIONS: The following undesirable plumbing practices are prohibited by State regulations: A. No direct connection between the public drinking water supply and potential sources of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an airgap or an appropriate backflow prevention device. B. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by installation of an airgap or a reduced pressure-zone backflow prevention device. C. No connection which allows water to be returned to the public drinking water supply is permitted. D. No pipe or pipe fitting which contains more than 0.25% lead may be used for the installation or repair of plumbing at any connection which provides water for human use. E. No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which provides water for human use. III. AGREEMENT TERMS: The following are the terms of the Service Agreement between: The City of Sunrise Beach, (the “Water Provider”) and customer. A. The Water System will maintain a copy of this Service Agreement as long as the Customer and/or premises is connected to the Water System. B. The Customer shall allow his property to be inspected for possible cross-connections and other unacceptable plumbing practices. These inspections shall be conducted by the City or its designated agent prior to initiating new water service; when there is reason to believe that cross- connections or other unacceptable plumbing practices exist; or after any major changes to the private plumbing facilities. The inspections shall be conducted during the City’s business hours. C. The Water System shall notify the customer in writing of any cross-connection or other undesirable plumbing practice which has been identified during the initial inspection or the periodic re-inspection. D. The Customer shall immediately correct any undesirable plumbing practice on his premises. E. The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the Water System. Copies of all testing and maintenance records shall be provided to the Water System. IV. ENFORCEMENT: If the Customer fails to comply with the terms of the Service Agreement, the Water System shall, at its option, either terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this Service Agreement shall be billed to the Customer. above Beach Provide I understand a Check or Money Order for $250.00 must be received at City Hall before my account can be activated. City of Sunrise Beach City Hall 124 Sunrise Drive, Sunrise Beach, TX 78643 *I will mail my Deposit Check or Money Order to City HallI will bring my Deposit Check or Money Order to City Hall in personPlease use Mouse to enter Signature * Clear Signature Notice about Confidentiality of Customer Information *I agree to allow the disclosure of my personal and account information as identified by Texas Utilities CodeI DO NOT agree to allow the disclosure of my personal and account information as identified by Texas Utilities CodeNOTICE ABOUT CONFIDENTIALITY OF CUSTOMER INFORMATION Chapter 182 of the Texas Utilities Code as amended in 2021 by House Bill 872 provides that a government-operated Municipal Utility District may not disclose personal information (customer’s address, telephone number, and social security number) in a customer’s account, or any information related to the volume or units of utility usage or amounts billed or collected for such utility usage, unless the customer elects to allow such information to be disclosed. The Utilities Code requires the District to provide notice of the customer’s right to allow disclosure of his or her information. Therefore, if you wish to allow disclosure of your personal information, please check the box below and return this form to the District. NOTE: The District is allowed to disclose information in a customer’s account record to federal, state or local government officials; to District employees, officials and operations personnel; to consumer reporting agencies; to a contractor or subcontractor approved by and providing services to the District, the state, a political subdivision of the state, or the United States; or to any other provider of utility services. Please answer the math question below….. *What is 2 + 2 Submit Share this: Click to share on Facebook (Opens in new window) Facebook More Click to share on Nextdoor (Opens in new window) Nextdoor Post navigation Consumer Confidence Reports