Sandbrock Permit Application

Sandbrock Permit Application
Phase*
Tract*
Company Name*
Builder Phone Number*
Please enter a valid phone number.
Builder Email Address*
example@example.com
Accounts Payable Phone Number*
Please enter a valid phone number.
Accounts Payable Email Address*
example@example.com
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Lot*
Block*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Service*
Rates & Information

Due to Mustang Special Utility District upon receipt of this request; Meter Set Fee $750, Water Connection Fee $2,500, and a Water Deposit Fee $100. All water will be metered by meters to be furnished and installed by Mustang SUD. The meter and/or connection is for the sole use of the member or customer and is to serve water to only one dwelling or only one business, and does not permit the extension of pipe or pipes to transfer water from one property to another nor share, resell, or sub-meter to any other person, dwelling, business, property, etc.

Builder assumes financial responsibility for any damage, theft, or vandalism to any Mustang owned or installed component, to include, but not limited to, meters, RTR units, wires, boxes, and valves.
- All CSI’s and backflow reports must be submitted through SC Tracking Solutions:
  - www.sctrackingsolutions.com
  - Customer Service: 1-866-232-0174
If not submitted within 30 days of completion of home, there will be an interruption of service or future meter set requests will be held until proper documentation is received.

Bills are mailed out the 1st of each month and are due by the 15th. By signing below, I acknowledge and accept the rate order for Mustang SUD.

I understand that I will be responsible for these charges. These charges must be paid in full prior to placing the meter set on schedule.

An email will be sent with the account number once the permit is processed. Pay online by entering your MSUD account number in the account number field and 0.00 in the last payment amount field.
Electronic Signature Agreement

By providing your electronic signature below, you agree and acknowledge that:

1) your application will not be signed in the sense of a traditional paper document,

2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and

3) you may still be required to provide a traditional signature at a later date.
Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date
Receive an email copy of this form.
Email Address*
example@example.com
Should be Empty: