REQUEST FOR WATER METER INSTALLATION or REPLACEMENT
The undersigned owner of real property serviced by the Village of Nyack
Water Department (VNWD) requests that the VNWD install a water meter at the
following service address: ____________________________________________.
Water service is presently being or will be provided to the subject property via
account number __________________________.
I agree to pay $____________ for a ____ -inch water meter prior to VNWD
scheduling the delivery and installation of the requested meter.
If the requested meter is larger than one-inch (1”), the undersigned owner
agrees to pay VNWD $ __________ for a _______-inch meter and further agrees
to arrange for pick-up and installation of said meter.
The owner agrees to abide by any and all rules and regulations which
may at any time be adopted by the VNWD.
The undersigned agrees to hold the Village of Nyack and the Village of
Nyack Water Department, its agents and employees harmless from any
plumbing problems which presently exist or may arise as a result of metering the
Print Name of Property Owner
Signature of Property Owner