Sewer and Water Application

* required

E-Mail Address *


Name of Applicant

Phone #

Address of Requested Service

Name of Contractor

Phone # of Contractor

Address of Contractor

Contractor's Proof of Insurance

Property Zoning (Residential, Commercial, Industrial)


Size of Service

Size of Meter

Type of Service (All service connection pipes must be type K unless otherwise specified by Village)

Will property have a: (if you select one of these, a Backflow Preventer is required)


Name of Contractor, if different

Address of Contractor, if different

Contractor's Proof of Insurance

Type of Service

Size of Service

Type of Pipe Used: (Schedule 35 or 40 PVC pipe is usually used)

NOTE: Property owner is responsible for ALL costs of service.

Signature *

Please type the word from the image in this field.


Monday thru Friday
8:00 a.m. to 4:30 p.m.

Closed Noon to 1:00 p.m.


207 S. Brownson Ave.
P.O. Box 208
Kingsley, MI 49649

(231)263-7778 office
(231)263-2278 fax