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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 $50 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. The personal information on this form is collected under the authority of Section 33 (c) of the Alberta Freedom Of Information And Protection Of Privacy Act . The information will be used to process your application(s) and your name and address may be included on reports that are available to the public. If you have any questions on the collection and use of this information, please contact the FOIP Coordinator at (780) 352-3321. All pertinent information included in a written submission received from the public that is presented to a Council, Committee or Board meeting of the County of Wetaskiwin becomes part of the public meeting minutes, unless otherwise requested by the individual in writing. Any personal information pertinent to the issue (including but not limited to, name and legal land description) could be recorded in the public minutes of the meeting. 

Leave This Blank:


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

    This field is not part of the form submission.

41. Submit

* indicates a required field