Bridgestone MUD – Application for Utility Service

Application for Utility Service

Bridgestone Municipal Utility District

Application processing time is 2 business days. For next business day service, please visit our Spring location at 19720 Kuykendahl Rd. Spring, TX 77379, or call 281-651-0861.

Are you a company applying for Residential Utility Service?

Are you applying for Commercial or Residential Utility Service? *

Commercial
Residential

Address for Service Request - Street Address *

Address for Service Request - City, State Zip Code *

First Name of Applicant *

Last Name of Applicant *

Telephone Number

Date to Begin Service *

Billing Address - Street Address (Indicate If Same As Above)

Billing Address - City, State Zip Code (Indicate If Same As Above)

Rent, Own, or Manage Home?

Please provide lease agreement, closing disclosure, or management agreement. (.jpg or .pdf format) *

Click or drag a file to this area to upload.

Your Email *

Previous Address

Previous Address - City, State Zip Code

Please provide photo of ID/license. (.jpg or .pdf format) *

Click or drag a file to this area to upload.

Authorized Caller First & Last Name:

Additional Comments

The District requires a security deposit and application fee to setup service. Payment options will be emailed to you.

Statement of Responsibility

It is the customer's responsibility to ensure that the home is prepared for water service. Any leak after the meter, or inside the home, or damages arising from a leak or fixtures left open inside the home, will be the customer's responsibility.

I have read and accept the Statement of Responsibility: *

Applicant’s failure to adhere to all requirements contained in the District’s Rate Order may result in fines, penalties, and a delay or denial of service. A copy of the District’s Rate Order is available upon request.

E-Signature Authorization

First Name *

Last Name *

Drivers License Number *

Today's Date

I have read and accept the E-Signature Authorization:

Service Agreement

I. PURPOSE. The Bridgestone MUD (hereinafter referred to as the "District") 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 District enforces these restrictions to ensure the public health and welfare. Each customer must sign this agreement before the District will begin service.
II. PLUMBING RESTRICTIONS. The following unacceptable plumbing practices are prohibited by State regulations.
A. No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air-gap 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 the installation of an air-gap 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. SERVICE AGREEMENT. The following are the terms of the Service Agreement between the District and the undersigned Customer (the "Customer"):
A. The District will maintain a copy of this agreement as long as the Customer and/or the premises is connected to the District's water system.
B. The Customer shall allow his property to be inspected for possible crossconnections and other unacceptable plumbing practices. These inspections may be conducted by the District 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 District's normal business hours.
C. The District shall notify the Customer in writing of any cross-connection or other unacceptable plumbing practice which has been identified during any inspection.
D. The Customer shall immediately correct any unacceptable plumbing practice on his premises.
E. The District shall, at the owner’s expense, properly install, test, and maintain any backflow prevention device required by the District. Copies of all testing and maintenance records shall be provided to the owner.

IV. Enforcement. If the Customer fails to comply with the terms of this Service Agreement, the District shall terminate service. Any expenses associated with the enforcement of this Service Agreement shall be billed to the Customer.