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WATER AND WASTEWATER CONNECTION REQUEST FOR SERVICE

  1. PROJECT LOCATED*

  2. WILL PROPERTY REQUIRE A REPLAT, SUBDIVISION, OR A LOT SPLIT? *

  3. (Residential, Multi-Family, Commercial, Retail, etc.)

  4. If the file doesn't upload, it can be emailed to gcarnahan@cityhs.net

  5. (i.e. number of lots, number of restrooms, number of bedrooms, number of office workers, number of customers and/or average daily water use, etc.)

  6. SELECT ALL THAT APPLY*

  7. I, the [applicant, requestor, etc.] for this form, warrant the truthfulness of the information provided in this request for service. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

  8. ACKNOWLEDGEMENT*

  9. Call 501-321-6861

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  19. Leave This Blank:

  20. This field is not part of the form submission.