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* indicates a required field

2. Account #*
3. Effective Date:*
   Effective Date:
4. Service:*

   1. Water
   2. Sewer
   3. Garbage
5. Requirement:*

   1. Connect
   2. Disconnect
   3. Other
7. Comments:
9. Email:*
10. Telephone:*
12. Property Owner's Name:*
14. Service Address:*
16. Legal Land Description: (Choose one)
18. Quarter:
19. Section:
20. Township:
21. Range:
23. Meridian:
    -- Select One --4th5th
25. OR
27. Plan:
28. Lot:
29. Block:

31. Cancellation of Service:

    In accordance with Bylaw 2022/04 of the County of Wetaskiwin No. 10, for the purpose of solid waste collection, "If services are provided, 100% participation is mandatory for all defined residential premises.

    In accordance with Bylaw 2020/67 of the County of Wetaskiwin No. 10, for the purpose of water and wastewater distribution systems, "Sewer service cannot be disconnect unless excavated and physically blocked."

    Fees:

    Owners will be charged a $52 connection/disconnection fee per request.

    Processing Timeline:

    A minimum of 5 business days are required for all requests and will be processed during business hours.

33. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, and 2) by signing in this alternate manner, your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I consent
35. Electronic Signature
37. Protection of Privacy Act

    The personal information collected through this Utility Request Form is for the purpose of managing utilities requests for connection, disconnection, and inquiries. This collection is authorized by Section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321.

    
    

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit