Application to Install Private Irrigation System Name First Last Applicant Email Address where irrigation system will be installed Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contractor/Plumber A 3/4" or 1" water meter and backflow prevention device will be installed after the domestic water supply meter. Inspection of water supply connection and back flow prevention device will be required by the City of Wahpeton staff after installation. Applicant agrees to comply with the terms of the ordinances and regulations hereto. Further, as a consideration of securing said water, agrees to pay the City of Wahpeton the water rates and any other remounts required by Ordinance or regulation and agrees that any amount that may become due and delinquent (including all penalties thereon) may be returned by the City of Wahpeton as taxes and that said property be liable for payment of the same. Installation Date MM slash DD slash YYYY SignatureToday's Date MM slash DD slash YYYY A fee of $265.75 is due. Please drop off or mail payment to city hall. Fee details: $225 meter and remote, $25 permit/Inspection Fee, $15.75 - 7% tax.